POLIOMYELITIS 

(INFANTILE  PARALYSIS) 


I'I.ATK  A.      Intervertelmd    foramen   with   the  periostea! 

extending  into  the  vertebral  canal  peeled  back.     The  membranes  arc 

died  hack  to  expose  the  "ord.     A  cord  segment  is  removed  to 

show  the  vascularization  of  the  white  and  grey  matter.     (Sen  KM  me.) 


PLATE  B. — Vortical  section  of  the  vertebral  (anal  with  the  periostea!  lininir 
shown  in  the  upper  portion.  The  dura  has  boon  drawn  away  slightly.  The 
vortobral  ligaments  and  venous  arrangement  may  be  seen. 

'In  the  lover  portion  the  membranes  arc  drawn  aside  to  expose  a  seHioii 
of  the  eon!.  Still  lower  spinal  nerve  with  the  sheath  of  the  dura. 


POLIOMYELITIS7 

(INFANTILE  PARALYSIS) 


i^DITED  BY 

FTP.  MILLARD,  D.  0. 

TORONTO 

Graduate  of  the  American  School  of  Osteopathy,  Kirksville,  Missouri. 

Founder  of  the  National  League  for  the  Prevention  of  Spinal  Curvature. 

Editor  of  the  Journal  of  National  League  for  the  Prevention  of  Spinal  Curvature. 

Anatomical  Artist. 

Producer  of  Various  Charts;  Anatomical  Chart  of  the  Spinal  and  Sympathetic 
Nerves;  Spinal  Lesion  Charts;  The  Sympathetic  System,  Etc.,  Etc. 

Originator  of  the  Water-marked  Spine  in  Stationery  for  Osteopaths. 
Conductor  of  Tri- Weekly  Clinics  for  Chronic  Cases  of  Infantile  Paralysis. 


COPYRIGHTED  1918 


97  ILLUSTRATIONS 
14  FULL  PAGE  PLATES 


PRINTED  BY 

JOURNAL  PRINTING  COMPANY 
KIRKSVILLE,  MISSOURI 


DEDICATED 
to  the  memory  of  the  late 

Dr.  A.  T.  STILL 
Founder  of  the  Science  of  Osteopathy 


PREFACE 

In  undertaking  to  publish  a  book  on  the  subject  of  Polio- 
myelitis, the  author  is  aware  that  this  is  not  the  first  attempt 
made  along  this  line.  Our  medical  co-workers  have  contrib- 
uted their  quota,  presenting  their  side  of  the  subject,  and  giv- 
ing their  viewpoint  regarding  causative  factors  and  treat- 
ment. This  is,  however,  the  first  attempt  to  produce  a  book 
on  this  subject  from  the  osteopathic  viewpoint. 

We  have  as  our  illustrious  guide  the  late  Dr.  A.  T.  Still, 
originator  and  founder  of  the  science  of  Osteopathy.  No 
greater  philosopher  ever  lived,  and  no  greater  physician  ever 
served  as  a  benefactor  to  the  human  race.  His  evolution  of 
the  therapeutics  of  adjustment,  adjustment  of  the  skeletal 
tissues,  which  has  already  done  much  to  modify  medical 
practice,  is  practically  new  to  the  world. 

All  over  this  fair  land  multitudes  of  people  once  lame, 
crippled  or  bedridden  have  been  restored  to  health  and  hap- 
piness. Dr.  Still  paved  the  way  for  this  new  method  of  treat- 
ing Infantile  Paralysis.  His  reasonings  were  those  of  a  sane 
man,  a  sage,  a  peer.  His  contention  that  the  rule  of  the 
artery  is  supreme,  and  that  the  moment  the  circulation  to  any 
part  of  the  body  is  interfered  with  that  moment  a  diseased  or 
disturbed  condition  arises  or  is  in  the  making,  is  genuine  phil- 
osophy and  will  stand  for  all  time. 

Not  since  the  discovery  of  the  circulation  of  the  blood 
by  Harvey  has  more  significant  logic  been  deduced  and  sub- 
stantiated. His  ideas  regarding  the  invasion  of  germs  and 
their  destructive  tendencies  thru  their  toxins  acting  upon 
tissues  devitalized  from  obstructed  circulation,  is  no  less  true, 
and  will  go  down  thru  history  unchallenged.  The  cause  of 
Infantile  Paralysis  will  be  taken  up  in  the  first  chapter,  and 
is  based  upon  Dr.  Still's  reasonings. 


x  POLIOMYELITIS 

We  are  indebted  to  our  fellow  co-workers  for  many  case 
reports,  and  data  found  in  this  small  volume.  To  the  Osteo- 
pathic  Physician,  we  wish  to  give  credit  for  case  reports  7 
to  36. 

To  Dr.  A.  G.  Walmsley,  especial  thanks  is  due  for  his 
able  collaboration  in  producing  this  work.  Of  assistance 
rendered  in  various  ways  by  Dr.  Walmsley,  aside  from  the 
chapters  contributed  by  him,  may  be  mentioned  reading 
the  proofs  and  preparing  the  comprehensive  index  found  in 
this  volume. 

We  trust  the  reading  of  this  little  book  may  stimulate 
others  to  follow  along  the  lines  that  Dr.  Still  gave  to  the 
world  in  the  last  quarter  of  the  nineteenth  century. 

F.  P.  MILLABD,  D.  O. 
May,  1918. 


CONTENTS 

INTRODUCTION 
A  brief  outline  of  the  scope  of  this  work 1 

CHAPTER  I. 

Poliomyelitis  (Infantile  Paralysis) — Causes 5 

Mode  of  Infection 9 

CHAPTER  II. 

Applied  Anatomy 11 

Lesions  Affecting  the  Blood  Supply  of  Spinal  Cord  and  mem- 
branes 

Cervical  Lesions 15 

Dorsal  Lesions 19 

Lumbar  Lesions 22 

Sacral  Lesions 23 

CHAPTER  III. 

Applied  Anatomy — continued 25 

Lymphatics  of  Head  and  Neck 

CHAPTER  IV. 

Applied  Anatomy — continued 36 

Lymphatics  of  the  Thorax  and  Abdomen. 

CHAPTER  V. 

Treatment— Part  One 43 

Acute  Cases 48 

Treatment— Part  Two 50 

Procedure  in  Acute  Cases 52 

Caution 57 

CHAPTER  VI. 

Hints  to  the  Public  on  Infantile  Paralysis 60 

CHAPTER  VII. 

Infantile  Paralysis 65 

CHAPTER  VIII. 

Case  Reports 81 

CHAPTER  IX. 

Osteopathic  Treatment  Versus  Medical  Treatment  of  Infantile 

Paralysis 149 


ILLUSTRATIONS 

Frontispiece — Plates  A  and  B 

Plate  C.    Entrance  and  direction  of  invading  germs 6 

Plate  D.   The  vascularization  of  the  spinal  cord 14 

Plate  E.    The  central  nervous  system 16 

Plate  F.    The  spinal  cord  and  nerves  in  situ 18 

Plate  G.    Anterior  view  of  the  cord  and  membranes 27 

Plate  H.   Right  lateral  view  of  the  cord,  and  the  formation  of  the 

spinal  nerves 29 

Plate  I.     Left  lateral  view  of  spinal  cord  and  membranes.  . 31 

Plate  J.     Posterior  view  of  spinal  cord 33 

Plate  K.   Vascularization  of  the  central  nervous  system 37 

Plate  L.    Braces  and  crutches  removed  by  osteopathic  measures 

(author's  cases) 44 

Plate  M.  "Intramural" 56 

Plate  N.   The  ligamentous  bands  that  hold  the  spine  together,  etc. .  .  59 

Fig.     1.  The  chest  box  or  thorax : 7 

Fig.     2.  Spinal  pads  or  bumpers 9 

Fig.     3.  Vascularization  of  a  section  of  the  spinal  cord 10 

Fig.    4.  Blood  supply  of  the  brain  and  spinal  cord 12 

Fig.     5.  Relative  position  of  the  spinal  cord  to  the  heart  and  aorta.  .  17 

Fig.     6.  Back  view  of  the  spine 20 

Fig.     7.  Front  view  of  the  spine .  . 20 

Fig.     8.  Square  shoulders,  even  hips  etc 21 

Fig.     9.  The  sympathetic  nerves 23 

Fig.  10.  The  nerves  of  the  extremities 24 

Fig.  11.  The  brain  is  well  supplied  directly  from  the  heart 26 

Fig.  12.  The  circulation  to  the  head .....: 34 

Fig.  13.  Faint  view  of  the  nerves  involved  in  infantile  paralysis ....  38 

Fig.  14.  A  perfect  spine  has  no  lesions 40 

Fig.  15.  Enlarged  sections  from  the  three  regions  of  the  spine 42 

Fig.  16.  Section  of  the  spine 43 

Fig.  17.  The  spinal  cord  is  a  continuation  of  the  brain, 46 

Fig.  18.  Nerve  impulses  travel  downward  from  the  brain,  etc 47 

Fig.  19.  At  birth  the  spinal  cord  is  almost  the  length  of  the  spine ...  49 

Fig.  20.  The  circulation  in  the  feet,  etc 51 

Fig.  21.  "Spinal  marrow" .53 

Fig.  22.  A  normal  spine  and  normal  poise 55 

Fig.  23.  Vertebrae,  spinal  pads,  spinal  cord  etc . , 58 


ILLUSTRATIONS  xm 

Fig.  24.  Spinal  curvature 61 

Fig.  25.  Dr.  Florence  Gair's  sanatorium  in  Brooklyn 66 

Fig.  26.  Dr.  Gair's  collection  of  braces,  casts,  etc 67 

Fig.  27.  Last  winter's  case  (winter  1918) 68 

Fig.  28.  Paralyzed  from  chin  to  toes 69 

Fig.  29.  Boy  age  three 70 

Fig.  30.  Note  the  improvement  as  shown  in  case  31 72 

Fig.  31.  Same  as  case  30 73 

Fig.  32.  "Three  ambulance  calls  had  refused  to  take  him,  as  he 

was  considered  too  far  gone 74 

Fig.  33.  This  boy  was  practically  helpless. 75 

Fig.  34.  A  bad  case  of  talipes t .76 

Fig.  35.  Bulbar  paralysis  in  right  side  of  face 77 

Fig.  36.  Same  as  Fig.  39 79 

Fig.  37.  She  can  now  stand  on  her  legs  again , 80 

Fig.  38.  Nerve  mechanism  down  thigh,  etc 82 

Fig.  39.  Spinal  curvature  ease  greatly  helped 83 

Fig.  40.  Front  view  of  the  pelvis '. 84 

Fig.  41.  Relationship  of  the  spinal  cord  to  the  atlas  and  sacrum 85 

Fig.  42.  Hand  everted.     Lesion  at  4th  cervical 87 

Fig.  43.  Back  view  of  the  pelvis 89 

Fig.  44.  Tilted  hips  and  spinal  curvature 90 

Fig.  45.  Lack  of  symmetry  in  spinal  curvature 91 

Fig.  46.  Shortening  of  a  leg  following  infantile  paralysis 93 

Fig.  47.  Brace  removed  six  years  after  an  attack  of  infantile  paralysis  95 

Fig.  48.  Well  developed  curvature  in  a  neglected  case 96 

Fig.  49.  Neglected  cases 97 

Fig.  50.  Case  restored  to  normal  by  osteopathic  treatment 99 

Fig.  51.  Back  view  of  case  50 100 

Fig.  52.  Brace  removed  from  infantile  paralysis  case  (author's  case) .  .  101 

Fig.  53.  Brace  removed  after  two  years'  use  (author's  case) 103 

Fig.  54.  The  nerves  of  the  arm 104 

Fig.  55.  Braces  taken  off  by  the  score 105 

Fig.  56.  Plaster  paris  cast  removed  from  boy  aged  3  (author's  case)  106 

Fig.  57.  Curvature  weakens  the  body •.  .  107 

Fig.  58.  Difference  in  length  of  limbs  causes  spinal  curvature 108 

Fig.  59.  Level  shoulders  and  hips 109 

Fig.  60.  Curvature  undermines  the  health 110 

Fig.  61.  Shortened  and  withered  leg,  tilted  hips  and  affected  nerves.  .111 

Fig.  62.  Perfectly  shaped  lungs 113 

Fig.  63.  The  bony  framework  protects  the  central  nervous  system.  .114 


xiv  POLIOMYELITIS 

Fig.  64.  Brace  for  a  girl  of  seven  years 116 

Fig.  65.  "Hipping  out" 117 

Fig.  66.  The  nerve  mechanism  of  the  leg 118 

Fig.  67.  The  normal  arch  of  the  foot 120 

Fig.  68.  "Broken  arch" 121 

Fig.  69.  "The  spinal  column  is  literally  alive  with  nerves" 122 

Fig.  70.  The  spinal  cord  and  the  spinal  column 124 

Fig.  71.  Watch  the  kidneys  in  paralysis  cases 126 

Fig.  72.  Back  view  of  Fig.  71 ' 127 

Fig.  73.  A  section  of  the  spine  cut  in  half 129 

Fig.  74.  The  tonsils  and  Eustachian  tubes 131 

Fig.  75.  The  chest  is  hung  onto  the  spine 133 

Fig.  76.  The  attachment  of  muscles  of  spine,  shoulder  blades,  etc.  .135 

Fig.  77.  Bones  bound  together  by  ligaments 136 

Figs.  78,  79.  The  normal  chest  is  conical  in  shape 138 

Fig.  80.  Framework  of  the  house  which  we  live  in 140 

Fig.  81.  We  are  shorter  at  night  than  in  the  morning 141 

Fig.  82.  Nature's  method  of  nourishing  the  spinal  cord,  etc 142 


INTRODUCTION 

N  PRESENTING  the  thoughts  contained  in  this  book 
on  the  subject  of  infantile  paralysis,  it  has  been  the  de- 
sire  of  the  author  and  of  his  collaborators  that  this  work 
should  not  receive  the  criticism  that  so  frequently  is  levelled 
at  a  one-man  production.  Having  this  thought  in  mind, 
every  effort  was  directed  to  the  end  that  this  work  should 
have  what  might  be  termed  a  cosmopolitan  flavor.  The 
chapters  contributed  by  others  than  the  author,  along  with 
the  most  excellent  array  of  case  reports  herein  contained, 
are,  we  believe,  a  fulfillment  of  the  end  aimed  at.  No  one 
who  is  interested  in  the  subject  of  poliomyelitis  should  fail 
to  read  this  work.  After  reading  the  chapters  on  Etiology, 
Applied  Anatomy,  Treatment,  etc.,  the  reader  should  care- 
fully study  the  case  reports.  It  is  surprising  how,  time  and 
again,  the  physicians  submitting  the  case  reports — appar- 
ently, sometimes  wittingly,  sometimes  unwittingly — drive 
home  the  truth  of  the  statements  made  in  the  chapters  on 
Applied  Anatomy  and  Treatment.  Among  the  things  that 
are  brought  out  by  the  case  reports  the  following  deserve 
special  mention: 

First. — Those  who  have  had  experience  with  poliomye- 
litis are  unanimous  and  emphatic  in  their  contention  that 
the  earlier  the  osteopath  gets  the  case  the  better.  A  study 
of  the  case  reports  leaves  no  doubt  that  Osteopathy  is  THE 
treatment  for  poliomyelitis  in  the  early  stages.  The  more 
severe  the  case  and  the  greater  and  more  urgent  the  necessity 
for  the  ministrations  of  the  osteopath. 

Second. — The  symposium  of  case  reports  shows  beyond  a 
doubt  that  Osteopathy  is  the  only  treatment  that  offers 
real  hope  of  improvement  or  cure  in  any  and  all  stages  of 
the  disease.  Whether  the  case  is  of  a  few  days'  standing 
or  whether  years  have  elapsed  since  the  attack,  Osteopathy 
is  the  ONLY  treatment  that  has  accomplished  anything  worth 
while. 

Third. — The  average  medical  man  seems,  and  actually 
is,  almost  helpless  in  treating  infantile  paralysis.  His  policy, 
for  the  most  part,  is  one  of  watchful  waiting  until  the  acute 


2  POLIOMYELITIS 

stage  is  past.  Then  he  will  make  an  attempt  to  overcome 
the  resulting  paralysis  and  deformity.  But  in  this  last 
effort  his  armamentarium  lacks  means  whereby  the  desired 
end  may  be  attained,  and  it  is  because  of  this  fact  that  one 
is  justified  in  pronouncing  the  medical  treatment  of  polio- 
myelitis an  abject  failure.  The  drugs  administered  during 
the  more  distressing  stages  of  the  disease  undoubtedly  handi- 
cap rather  than  help  nature,  and  fortunate  are  those  polio- 
myelitis cases  who  escape  drug  treatment. 

Fourth. — A  reading  of  the  case  reports  brings  out  the 
fact  that  quite  a  number  of  osteopaths  who  treated  infantile 
paralysis  cases  were  rather  timid  about  undertaking  to  do  so. 
They  had  not  had  experience  with  the  disease  and  were  not 
sure  of  what  they  could  do.  But  they  applied  themselves 
diligently  to  the  cases  once  they  had  taken  charge  of  them, 
and  in  many  of  these  cases  the  results  obtained  were  vastly 
more  satisfactory  than  they  had  expected.  Such  results 
could  not  help  making  enthusiasts  of  them,  and  it  will  be 
noted  that  everyone  who  submitted  case  reports,  with  per- 
haps one  or  two  exceptions,  became  highly  enthusiastic  over 
the  showing  Osteopathy  made  in  the  treatment  of  poliomye- 
litis. Some  are  so  enthusiastic  that  they  unhesitatingly 
claim  that  Osteopathy  is  a  specific  treatment  for  the  disease 
if  the  case  is  had  soon  enough. 

Fifth. — Of  the  various  means  resorted  to  to  comfort 
and  alleviate  the  distress  of  the  patient  in  the  acute  stage 
of  the  disease,  we  desire  to  call  attention.  Poliomyelitis 
is  one  of  the  acute  diseases  in  which  the  best  and  most  at- 
tentive nursing  are  highly  necessary.  The  means  applied 
and  the  results  obtained,  as  outlined  in  the  case  reports,  are 
deserving  of  careful  reading. 

Sixth. — If  we  may  be  permitted  to  express  an  opinion 
on  one  point  which  we  feel  is  sufficiently  evident  from  the 
case  reports  submitted,  it  is  that  in  many  of  the  cases  re- 
ported the  treatment  was  not  continued  as  long  as  it  should 
have  been.  We  cannot  help  feeling  that  if,  in  a  number  of 
the  cases  reported,  the  treatment  had  been  continued  six 
months  or  a  year  longer  much  more  would  have  been  ac- 
complished. A  continuance  of  the  treatment  can  do  no 
harm,  and  it  may  do  much  good.  Therefore,  why  give  up 
while  there  is  the  slightest  hope  of  further  improvement? 


INTRODUCTION  3 

Seventh. — It  will  be  noted  that  the  hospitals  of  the 
country  were  not  open  to  the  osteopaths  to  treat  infantile 
paralysis  cases  in  them.  In  fact,  under  the  quarantine 
regulations  now  in  force  in  the  United  States  and  Canada, 
it  is  next  to  impossible  for  an  osteopath  to  get  a  case  of  in- 
fantile paralysis  in  the  acute  stage.  The  great  Rockefeller 
Institute,  the  greatest  research  institute  in  the  United  States 
and  perhaps  in  the  world,  is  controlled  by  the  medical  ma- 
chine. It,  through  the  veto  of  Dr.  Simon  Flexner,  refused 
to  allow  an  osteopath  to  demonstrate  what  could  be  done  by 
Osteopathy  for  the  victims  of  infantile  paralysis  that  were 
languishing  within  its  walls.  In  the  face  of  such  prejudice 
in  high  places,  the  broad-mindedness  of  those  few  M.  D.'s 
who,  when  they  realized  they  could  do  nothing  for  infantile 
paralysis,  referred  their  patients  to  osteopaths,  stands  out 
in  bold  relief.  If  the  general  public  realized  what  Oste- 
opathy has  done  and  can  do  for  infantile  paralysis  in  all 
stages,  one  cannot  help  feeling  that  they  would  vigorously 
protest  against  the  domination  of  the  great  medical  octopus 
and  demand  that  the  victims  of  infantile  paralysis  have  the 
right  to  employ  an  osteopathic  physician  if  they  so  desired. 
May  we  hope  that  in  the  great  fight  for  democracy  that  is 
now  being  waged  we  will  achieve  a  democracy  that  will 
vouchsafe  medical  freedom  to  the  masses? 

So  far  as  we  are  aware,  this  is  the  first  work  on  infantile 
paralysis  in  which  the  applied  anatomy  of  the  spinal  cord  is 
discussed  in  all  its  phases.  We  believe  that  a  study  of  the 
applied  anatomy  of  the  spinal  cord,  and  of  the  osteopathic 
interpretation  thereof,  cannot  fail  in  being  of  invaluable  help 
to  the  practician  who  may  be  called  upon  to  treat  infantile 
paralysis  or  other  inflammatory  conditions  of  the  spinal  cord. 

Scattered  over  the  country  there  are  thousands  of  cases 
of  club  foot  and  other  deformities  of  the  feet  and  limbs  that 
have  resulted  from  infantile  paralysis.  Under  proper  treat- 
ment most  of  these  cases  can  be  helped  and  many  of  them 
cured.  The  osteopathic  profession  has  an  orthopedic  spec- 
ialist who,  we  believe,  is  second  to  none,  in  the  person  of  Dr. 
George  M.  Laughlin  of  Kirksville,  Missouri,  and  it  is  with 
pleasure  that  we  refer  the  reader  to  the  chapter  on  the  treat- 
ment of  deformities  by  Dr.  Laughlin. 


4  POLIOMYELITIS 

But  lest  the  practician  be  inclined  to  haste  in  advising 
orthopedic  measures,  not  realizing  how  much  may  be  ac- 
complished by  osteopathic  procedure,  we  would  suggest  a 
careful  reading  of  the  chapters  by  Dr.  E.  Florence  Gair.  Dr. 
Gair  admits  that  in  many  cases  showing  marked  deformity 
the  results  obtained  surpassed  her  fondest  expectations,  and 
some  of  these  cases  were  helped  in  a  remarkably  short  time. 
The  chapters  by  Dr.  Gair  cannot  fail  to  encourage  and  en- 
thuse those  whose  experience  with  such  cases  has  been  limited 
and  whose  outlook  therefore  lacks  the  vision  born  of  ex- 
perience. The  first  chapter  by  Dr.  Gair  (Chapter  Seven) 
appeared  in  the  August  issue  of  the  Osteopathic  Magazine. 
This  was  the  result  of  a  misunderstanding,  as  it  was  written 
especially  for  this  book. 

A.  G.  WALMSLEY. 


CHAPTER  I 

POLIOMYELITIS 

(INFANTILE  PARALYSIS) 

Causes 

Practically  all  agree  that  Infantile  Paralysis  is  a  germ 
disease,  and  that  the  germ  gains  entrance  thru  the  nasal  and 
oral  openings.  Undoubtedly  the  germ  is  present  in  many 
instances  within  the  body.  In  order  that  germs  may  cause 
destruction  of  tissue,  there  must  be  suitable  soil  for  them  to 
increase  and  give  off  their  toxic  products.  Suitable  soil  will 
be  that  found  in  devitalized  tissues  when  circulation  has  be- 
come disturbed. 

Stasis  is  produced  whenever  the  circulation  has  become 
impeded. 

There  may  be  a  vasomotor  disturbance  causing  a  varia- 
tion in  the  calibre  of  the  walls  of  the  blood  vessels,  or  there 
may  be  direct  mechanical  blockage  at  some  point  along  the 
course  of  the  blood  vessels. 

Osseous  lesions  may  cause  vascular  disturbance 
through  the  various  nerve  tracts  that  connect  the  spinal 
nerves  with  the  autonomic  nervous  system.  Later  on  we  will 
discuss  this  phase  of  causative  principles  under  the  heading 
of  applied  anatomy.  There  is  always  the  possibility  of  an 
hereditary  diathesis  producing  a  nervous  instability  that  ren- 
ders the  tissues  more  liable  to  ataxic  conditions.  Thus  we 
find  an  example  in  certain  neurotic  subjects  and  in  cases  of  St. 
Vitus '  dance,  where  there  seems  to  be  an  inherent  tendency 
for  some  nervous  symptom  to  develop. 

In  the  majority  of  cases  wre  have  examined  and  treated 
we  have  noted  traumatic  conditions.  We  have  found  one  or 
more  spinal  or  costal  lesions  more  or  less  directly  influencing 
the  vascularization  of  the  membranes  of  the  spinal  cord. 

LESION  THEORY.  No  child  is  too  young  to  become 
lesioned  if  the  proper  mechanical  pressure  or  torsion  has  been 
applied.  We  have  observed  in  our  practice  in  many  cases  of 
instrument-delivered  babies  one  or  more  cervical  lesions. 
This  is  common  knowledge  to  the  osteopathic  physician. 
We  have  noted  various  forms  of  nervousness  develop  in  early 


POLIOMYELITIS 


PLATE  C.     The  arrow  indicates  the  entrance  and  direction  the  invading  germs 
follow  in  infantile  paralysis. 


POLIOMYELITIS  7 

life  caused  by  these  lesions  produced  when  the  child  was  born. 
The  obstetrician  did  not  realize  that  in  delivering  the  child 
with  the  forceps  the  cervical  tissues  were  injured  and  lesions 
produced.  It  did  not  occur  to  him  that  the  infant's  neck 
should  have  been  carefully  examined  and  if  any  lesion  existed 
an  adjustment  made  as  soon  as  possible. 


FIG.  1.  The  chest  box  or  thorax  containing  and  protecting  the  heart.  We  hear 
the  heart-beat  through  the  resonant  walls.  The  nervous  system  is  nourished  indi- 
rectly from  the  heart. 


8  POLIOMYELITIS 

He  did  not  reason  from  cause  to  effect  and  connect  the 
after  symptoms  of  a  nervous  phase  which  endangered  the 
child's  life  with  the  early  injury. 

The  lesion  produced  by  the  torsion  at  delivery  was  the 
beginning  of  a  vascular  irregularity  and  nerve  impulse  dis- 
turbance that  affected  the  tone  of  the  membranes  surrounding 
the  spinal  cord. 

Another  kind  of  lesion  quite  commonly  found  in  children 
is  one  produced  by  a  fall  or  twist.  Sometimes  a  child  will 
slip  out  of  the  nurse's  arms,  and  while  we  admit  that  the 
bones  are  soft  and  not  completely  formed  and  ossified,  yet 
we  know  that  lesions  have  been  made  in  this  manner,  as  clin- 
cal  experience  has  verified  in  our  everyday  practices. 

A  child  may  not  be  supported  properly  on  the  lap  and 
ma,y  throw  itself  backward  suddenly,  as  most  babies  do,  and 
that  act  may  lesion  the  spine  and  cause  pressure  upon  certain 
nerve  centres,  producing  such  symptoms  as  marked  gastric 
disturbances,  mental  irritation  or  even  convulsions  and 
epilepsy.  A  jealous  brother  or  sister  may  give  the  baby  a 
quick  push  on  the  head  and  lesion  its  neck.  There  are  many 
ways  to  lesion  the  spine  of  a  baby. 

After  a  baby  begins  to  walk  many  are  the  tumbles  out  of 
high  chairs,  cribs,  or  off  the  bed.  It  may  even  slip  on  the 
staircase  and  go  head  over  heels  down  to  the  floor  below. 

Does  it  sound  unreasonable  to  state  that  there  is  always 
a  possibility  of  a  child  lesioning  its  framework  under  circum- 
stances such  as  we  have  enumerated  above? 

One  of  the  most  marked  cases  of  St  Vitus'  dance  I  have 
treated  in  my  eighteen  years  of  practice  was  caused  by  a 
tumble  down  stairs.  Two  adjustments  at  the  fourth  cervical 
restored  the  child  to  normal.  Suppose  this  lesion  had  not 
been  corrected.  There  is  a  possibility  that  nature  would  have 
in  time  overcome  the  nervous  disturbance,  but  the  lesion 
would  still  be  present,  and  a  certain  amount  of  vascular  dis- 
turbance to  the  membranes  of  the  spinal  cord  would  continue 
to  be  present.  If  climatic  conditions  were  right  and  an 
epidemic  of  infantile  paralysis  was  spreading  over  that  com- 
munity, would  not  this  child,  with  weakened  tissues  around 
the  cord,  have  suitable  soil  for  invading  germs  to  harbour 
and  cause  destructive  work  in  the  spinal  cord  areas? 

We  are  now  leading  up  to  the  direct  cause  of  at  least  a 
number  of  cases  that  contract  infantile  paralysis. 


POLIOMYELITIS  9 

Mode  of  Infection 

We  have  already  stated  the  most  commonly  accepted 
theory  regarding  the  entrance  of  germs  into  the  system,  viz., 
the  respiratory  and  the  deglutitory  tracts. 

Food  taken  into  the  mouth  while  being  masticated  may 
take  up  the  invading  germs  and  convey  them  during  degluti- 


FIG.  2.     Spinal  pads  or  bumpers.     When  piled  up  as  shown  at  the  left  they  equal 
one  quarter  of  the  length  of  the  padded  part  of  the  spine. 


10 


POLIOMYELITIS 


tion  into  the  stomach.  The  absorption  of  food  material  in 
the  form  of  chyle  will  allow  the  conveying  of  these  germs  into 
the  remotest  parts  of  the  system. 

If  there  already  exists  a  lowered  vitality  condition  of  the 
spinal  cord  membranes  thru  one  or  more  lesions,  as  mentioned 
above,  these  germs  wTill  find  suitable  soil  in  which  they  will 
increase  in  numbers  and  throw  off  their  toxic  products.  The 
static  blood  in  this  area  is  no  longer  properly  oxygenated,  and 
the  resistance  is  so  lowered  that  it  is  only  a  matter  of  a  few 
days  until  the  typical  symptoms  of  infantile  paralysis  mani- 
fest themselves,  and  we  find  the  little  patient  with  fever, 
nausea  and  all  of  the  other  symptoms  so  marked  in  a  typical 
case. 


FIG.  3.     Vascularization  of  a  section  of  the  spinal  cord.     Note  the  accessory 
artery  assisting  the  three  spinal  arteries. 

There  may  or  may  not  be  paralysis.  The  case  may  be  of 
the  abortive  type  and  the  circulation  may  clear  up  the  mem- 
branes sufficiently  that  the  cord  segments  will  not  be  invaded 
to  the  point  of  causing  destruction  in  the  motor  area  of  the 
cord. 

There  may  be  some  destruction  of  the  motor  cells  in  the 
cervical  enlargement  of  the  cord,  with  paralysis  of  one  arm,  or 
the  destruction  may  be  so  general  that  not  only  the  cervical 
enlargement  may  be  affected  but  the  lumbar  enlargement  as 
well.  We  may  find  that  complete  paralysis  has  taken  place, 
and  that  the  invasion  has  traveled  upward  and  caused  bulbar 
paralysis.  It  all  depends  upon  the  resistance  the  tissues  have 
against  invasion  and  destruction. 


CHAPTER  2 

APPLIED  ANATOMY 

Lesions  Affecting   the   Blood   Supply  of   Spinal   Cord 

and  Membranes 

The  vascularization  of  the  spine  includes  that  of  the  cord 
and  its  membranes. 

We  find  the  arrangement  of  the  vessels  such  that  one  set 
reinforces  another  thru  anastomoses.  The  spinal  arteries 
from  the  vertebral  are  the  longest  vessels  of  their  size  found  in 
the  body.  The  anterior  spinal  artery  is  given  off  by  two 
branches,  one  from  each  of  the  vertebrals.  They  unite  near 
the  atlas  to  form  one  long  slender  vessel  that  passes  downward 
under  the  linea  splendis  to  reach  the  filum  terminale.  It  is 
situated  in  front  of  the  anterior  median  fissure  of  the  cord 
and  sends  out  many  transverse  branches,  the  anterior  media, 
which  divide  into  the  commissural  arteries  that  supply  the 
major  part  of  the  grey  matter  of  the  cord.  This  central  or 
centrifugal  set  is  reinforced  by  spinal  branches  in  the  various 
regions  of  the  spine.  In  the  cervical  region  the  lateral  spinal 
branches  of  the  vertebral,  also  the  ascending  cervical  branches 
of  the  inferior  thyroid  entering  the  foramina  accompany  the 
anterior  and  posterior  roots  of  the  spinal  nerves.  In  the 
thoracic  region  we  have  the  spinal  branches  of  the  dorsal  divi- 
sion of  the  intercostal  arteries;  in  the  lumbar  region  the 
spinal  branches  of  the  lumbar  and  ilio-lumbar  arteries ;  while 
in  the  sacral  region  the  rami  spinalis  are  from  the  lateral 
sacral  arteries. 

These  vessels  reinforce  not  only  the  anterior  but  the 
posterior  spinal  arteries  as  well.  The  posterior  spinal  arteries 
are  two  in  number,  and  are  also  branches  of  the  vertebral 
arteries  given  off  above  the  atlas.  They  follow  the  spinal 
cord  just  back  of  the  posterior  nerve  roots,  and  extend  down 
the  full  length  of  the  cord.  The  posterior  spinal  arteries  sup- 
ply the  grey  matter  in  part  also  the  white  matter  in  the  pos- 
terior portion  of  the  cord.  They  are  referred  to  as  the  cen- 
tripetal set. 


12 


POLIOMYELITIS 


FIG.  4.  Blood  supply  of  the  brain  and  spinal  cord.  Note  the  spinal  arterie? 
are  given  off  from  the  vertebrals  at  the  base  of  the  brain  and  turn  downward  extending 
the  length  of  the  spinal  cord  and  its  membranes. 


APPLIED  ANATOMY  13 

The  reinforcing  arterial  branches  that  follow  the  nerve 
roots  to  the  cord  supply  the  dura  mater  and  pia  mater  and 
enter  the  cord  segments  passing  directly  toward  its  centre. 
This  arrangement  of  vessels  makes  a  centripetal  and  centrifu- 
gal group  that  supply  a  superficial  or  peripheral  area,  also  a 
central  and  intermediate  area. 

The  vessels  mentioned  above  not  only  supply  the  cord 
but  the  nerve  roots,  the  membranes  of  the  cord  and  the  per- 
iosteum lining  the  spinal  canal. 

This  indirect  method  of  vascularizing  the  spinal  cord  and 
membranes  is  interesting  to  note.  In  the  instance  of  the 
spinal  arteries  proper,  that  is  the  anterior  and  posterior 
spinal,  we  note  that  the  blood  forced  from  the  heart  upward 
toward  the  brain  is  turned  backward  and  downward  to  follow 
the  spinal  vessels.  This  arrangement  checks  the  arterial 
pressure,  and  gravity  is  given  an  opportunity  to  carry  the 
blood  to  the  filum  terminale  area. 

The  reinforcing  arteries  are  given  off  from  the  various 
arteries  mentioned  at  almost  right  angles,  and  in  the  thoracic 
region  we  find  first  the  intercostal  branches  at  almost  right 
angles  to  the  aorta,  and  then  the  spinal  branches  turning 
backward  and  inward  to  enter  the  foramina  to  reach  the 
cord.  Thus  in  each  instance  the  visi-a-tergo  is  lessened  and 
the  delicate  cord  and  its  membranes  are  protected  from  any 
direct  pressure,  even  though  the  heart  action  is  accelerated 
and  fever  is  rampant. 

The  drainage  of  these  areas  by  the  veins  is  somewhat  sim- 
ilar in  arrangement,  altho  the  greatest  vascular  area  is  at  the 
posterior  surface  of  the  cord. 

The  veins  pass  out  along  with  the  spinal  nerves  and  empty 
into  the  larger  veins  just  outside  the  vertebral  column. 

In  the  brain  we  find  the  circle  of  Willis  checking  the 
blood  force  and  distributing  the  blood  to  the  various  areas  of 
the  brain.  The  membranes  covering  the  brain  are  well  sup- 
plied by  arterial  branches  that  are  indirectly  given  off  by  the 
larger  branches  of  the  carotids.  In  congestion  of  the  spinal 
and  cephalic  areas  the  greatest  problem  is  the  venous  drainage. 
We  have  to  contend  with  lesion  effects  in  the  way  of  vasomo- 
tor  disturbances,  contracted  musculature,  overtense  tissues 
and  enlarged  glands. 


14 


POLIOMYELITIS 


PLATE  D.      The  vascularization  of  the  spinal  cord- 


APPLIED  ANATOMY  15 

Cervical  Lesions 

In  the  cervical  region  the  variety  of  lesions  is  numerous. 
The  lesioned  atlas  may  disturb  the  superior  cervical  ganglion, 
with  its  many  branches  going  to  the  carotid  vessels,  both  in 
the  cervical  region  and  in  the  cephalic.  This  ganglion  com- 
municates with  three  principal  cranial  nerves  almost  directly 
and  with  others  indirectly.  The  vascularization  of  the  brain 
and  membranes  covering  it  depends  normally  chiefly  upon 
undisturbed  impulses  from  the  vasomotor  centres  in  the  up- 
per thoracic  area.  If  the  preganglionic  nerve  tracts  are  inter- 
fered with  the  communication  with  the  postganglionic  in  the 
superior  ganglion  of  the  sympathetic  will  be  disturbed.  An 
atlas  lesion  may  also  affect  the  first  and  second  spinal  nerves 
and  likewise  cause  contraction  of  the  muscles  and  tissues  con- 
trolled and  supplied  by  them.  The  vagus  nerve  receives  a 
branch  from  the  superior  cervical  ganglion  and  the  distribu- 
tion of  the  vagus  is  so  far-reaching  that  a  lesioned  atlas  may 
cause  functional  or  organic  effects  in  one  or  more  of  the  dis- 
tributing centres  of  this  nerve. 

The  lowrered  tissue  vitality  found  where  there  is 
impeded  circulation  to  the  spinal  cord  and  membranes  will 
allow  invading  germs  to  destroy  tissues  that  otherwise  would 
resist  their  attacks  if  the  vascular  areas  were  normal.  The 
venous  stasis  from  contractured  musculature  will  remain  as 
such  unless  the  cause  is  removed.  Any  lesion  found  in  the 
cervical  region  or  other  regions  wTill  lower  spinal  cord  re- 
sistance. The  spinal  nerve  cells,  nerve  roots,  etc.,  are  nour- 
ished by  these  spinal  arteries,  and  they  must  not  be  com- 
pressed or  their  vasomotor  control  interfered  with  if  we  are 
to  expect  normal  tone  and  perfect  impulses. 

The  vertebral  artery  threads  its  way  through  the  upper 
six  transverse  processes  of  the  vertebrae.  Any  malalign- 
ment  of  any  of  these  vertebrae  will  affect  the  circulation  in 
the  spinal  branches  of  this  artery  on  either  side. 

The  other  arteries  in  this  region  contributing  spinal 
arterial  branches  will  also  be  affected  by  any  cervical  lesion 
or  lesions.  If  a  lesion  exists  in  the  axis  or  any  other  cervical 
vertebra  wre  find  a  corresponding  irritation  or  disturbed 
nerve  impulses  to  the  muscles  supplied  by  the  various  nerves. 
If  the  third  and  fourth  are  in  lesion  the  diaphragm  may  be 


16 


POLIOMYELITIS 


PLATE  E.     The  central  nervous  system. 


APPLIED  ANATOMY 


17 


involved  thru  the  phrenics.  This  will  add  to  the  seriousness 
of  matters  when  an  attack  of  paralysis  is  lowering  the  cord 
resistance  during  the  febrile  stage.  The  cervical  enlarge- 
ment of  the  cord  is  one  of  the  most  common  areas  attacked  in 
infantile  paralysis.  The  branches  of  the  cervical  nerves 
forming  the  brachial  plexus  may  lose  their  motor  control 
and  the  deltoid  and  other  muscles  of  the  shoulder  and  arm 


FIG.  5.     The  dotted  line  indicates  the  relative  position  of  the  spinal  cord  to  the 
heart  and  aorta. 

become  helpless.  Lesions  in  this  region  of  the  cord  will  al- 
low a  disturbed  vascularization  to  progress  more  rapidly 
because  the  vasomotor  tone  is  lowered.  Nature  is  not  able 
to  clear  up  and  throw  off  the  congestion  as  rapidly.  Con- 
gestion and  stasis  will  fail  to  clear  up  to  the  same  extent  as 
in  that  state  where  no  lesions  exist.  The  greatest  amount  of 


18 


POLIOMYELITIS 


PLATE  F.     The  spinal  cord  and  nerves  in  situ. 


APPLIED  ANATOMY  19 

congestion  in  the  cord  and  membranes  will  be  found  where 
the  most  marked  lesions  exist.  The  exciting  factor  men- 
tioned in  Chapter  One  under  the  head  of  causes  applies  to  the 
lesion  effects  we  are  discussing. 

Cervical  lesions  may  cause  contraction  of  the  scaleni 
muscles  and  draw  upward  the  first  and  second  ribs  to  which 
these  muscles  are  attached.  Over  the  first  rib  we  note  the 
subclavian  vessels  passing.  The  upward  drawing  of  the 
first  rib  will  interfere  and  carry  up  the  vessels  lying  in  close 
approximation.  The  artery  may  not  be  compressed,  but  the 
vein  with  its  thinner  walls,  may  be,  and  venous  stasis  in  the 
arm  will  result.  The  vasomotors  will  likewise  be  disturbed 
in  the  brachial  plexus  of  nerves,  and  we  will  find  the  arm  and 
hand  cold  and  lifeless.  The  motor,  vasomotor  and  trophic 
nerves  are  alike  affected,  partially  thru  the  lesioned  areas  as 
well  as  thru  the  pathological  state  of  the  cord  cells. 

We  have  all  noted  the  disturbances  to  these  various 
nerves  in  cases  where  cervical  lesions  existed  aside  from  any 
poliomyelitic  state.  We  find  one  or  more  fingers  partially 
numb,  the  hand  sometimes  quite  helpless,  as  in  writer's 
cramp  and  wrist-drop.  In  a  milder  way  there  may  be 
lowered  nerve  tone  and  vascular  effects  thru  the  vasomotors 
in  cases  free  from  paralytic  symptoms. 

Add  to  this  condition  an  attack  of  poliomyelitis  and 
obviously  we  see  the  lessened  chance  the  patient  has  to  over- 
come a  condition  that  is  complicated  by  lesion  effects  and 
cord  cell  destruction. 

If  an  attack  of  poliomyelitis  comes  to  one  with  lesion? 
already  existing  and  lowered  tissue  resistance,  the  chances 
for  a  more  marked  paralysis  condition  are  multiplied 

The  child  that  fell  or  in  some  manner  produced  a  lesion 
thru  torsion  is  the  child  that  is  more  apt  to  have  greater  de- 
struction of  the  motor  cells  when  attacked  by  poliomyelitis. 

Dorsal  Lesions 

In  the  thoracic  area,  as  in  the  cervical,  we  have  a  somewhat 
similar  proposition.  Although  the  spinal  cord  in  the  greater 
part  of  this  region  is  small  in  size  and  the  vertebrae  likewise, 
yet  we  find  in  this  region  some  of  the  most  important  vaso- 
motor centres.  It  is  in  this  region  that  we  note  the  presence 
of  grey  rami.  The  cervical  nerves  have  white  rami  only.  This 


20 


POLIOMYELITIS 


double  communication  with  the  autonomic  nervous  system 
makes  this  region  significant  in  the  way  of  vasomotor  im- 
pulses to  the  various  organs  of  the  chest  and  abdomen. 

We  have  already  mentioned  the  upper  thoracic  vaso- 
motor connection  with  the  head,  neck,  shoulders  and  arms. 


FIG.  6.  Back  view  of  the  spine.  Notice 
the  outline  of  the  outside  tips,  and  the  inner 
line  corresponding  with  the  articular  or  joint 
surfaces. 


FIG.  7.  Front  view  of  the  spine. 
The  inner  line  follows  the  bodies  of 
the  sections. 


APPLIED  ANATOMY 


21 


We  will  now  consider  the  great  outflow  of  vasomotor  im- 
pulses to  the  semilunar  ganglia  and  coeliac  plexus  thru  the 
splanchnics.  The  systemic  arteries  have  an  arrangement  of 
vasomotors  different  to  that  found  in  the  mesenteric  vessels 
of  the  abdomen.  On  the  one  hand,  we  find  the  preganglionic 
fibres  terminating  in  the  sympathetic  ganglia,  and  the  post- 
ganglionic  fibres  carrying  on  the  impulses  to  the  walls  of  the 
vessels.  In  the  mesenteric  vessels  we  find  the  preganglionic 
fibres  have  passed  to  and  thru  the  sympathetic  ganglia,  and 
on  to  the  mesenteric  ganglia  where  the  postganglionic  fibres 
convey  the  impulses  to  regulate  the  abdominal  vessels  in  the 
bowels. 

Lesions  found  in  the  thoracic  vertebrae  are  no  less 
important  than  those  found  in  the  costal  area.  The  sympa- 
thetic ganglia  from  the  first  thoracic  down  are  in  close  prox- 
imity to  the  heads  of  the  ribs.  The  subluxation  of  the  first 


FIG.  8.     Square  shoulders,  even*  hips,  and^a  spine  free  from  curvature  insures 
normal  freedom  of  circulation  and  of  nerves. 


22  POLIOMYELITIS 

rib  may  cause  disturbance  in  the  stellate  ganglion  and  like- 
wise cause  a  vasomotor  effect  to  the  blood  vessel  walls  in  that 
region.  The  lesions  found  in  any  costal  subluxation  in  each 
instance  will  disturb  the  corresponding  ganglia  found  in  re- 
lation to  the  head  of  that  rib.  If  in  the  splanchnic  area,  the 
disturbance  will  be  marked,  as  the  splanchnics  convey  vaso- 
motors  to  the  important  organs  in  the  region  of  the  coeliac 
plexus. 

Costal  lesions  not  only  disturb  the  vasomotors  but 
affect  the  intercostal  vessels,  nerves  and  muscles. 

Here  again  we  will  note  that  these  lesions  will  interfere 
with  the  spinal  vessel  branches  supplying  that  area  of  the 
spinal  cord  and  its  membranes. 

Costal  lesions  may  affect  the  diaphragm  in  the  region 
where  that  dome-shaped  muscle  attaches  itself  to  the  inner 
thoracic  walls. 

The  passing  of  the  splanchnic  nerves  thru  the  crura  of 
the  diaphragm  may  be  disturbed  by  thoracic  and  lumbar 
lesions  as  well  as  costal.  The  aorta  may  be  compressed  as  it 
passes  thru  the  opening,  for  it  is  in  relation  to  the  fibrous  por- 
tion of  the  diaphragm.  The  cardiac  nerves  found  in  the 
cervical  and  upper  thoracic  may,  if  lesions  exist,  cause  ir- 
regularity of  heart  action. 

Lumbar  Lesions 

In  the  lumbar  portion  of  the  spinal  canal  we  find  reinforc- 
ing arteries  helping  to  supply  the  nerves  and  their  coverings 
that  go  to  supply  the  lower  extremity. 

While  all  these  nerves  are  given  off  from  the  lumbar 
enlargement  of  the  cord  above  the  second  lumbar  vertebra, 
yet  these  nerves  must  receive  a  blood  supply  to  be  properly 
nourished.  The  membranes  of  the  cord  extend  below  the 
cord  and  protect  these  nerves  until  they  are  all  finally  given 
off  and  pass  out  of  the  foramina  in  this  and  the  sacral  region. 

The  lumbar  nerves,  if  interfered  with  by  lumbar  or 
lumbo-sacral  lesions,  will  lose  their  tone,  and  a  lowered  re- 
sistance of  the  muscles  and  tissues  of  the  limbs  will  result. 
The  renal  plexus  will  be  affected  by  upper  lumbar  lesions 
and  the  pelvic  organs  and  vessels  will  become  congested  if 
lesions  are  present  in  this  region. 

The  paralysis  found  in  the  bladder  and  bowels  may  be 
aggravated  by  the  presence  of  osseous  lesions. 


APPLIED  ANATOMY 


23 


The  additional  cord  segment  pathology,  whether  con- 
gestion alone  or  cell  deterioration  or  partial  destruction  is 
found,  will  be  harder  to  clear  up  if  the  vasomotor  tone  is 
already  impaired. 

Sacral  Lesions 

The  sacrum  is  wedged  between  the  innominates,  and 
upon  it  rests  the  spinal  column.  It  is  common  to  note  a 
sacro-iliac  lesion,  and  we  find  with  the  rotation  of  the  in- 
nominate upon  the  sacrum  a  corresponding  difference  in 
the  length  of  the  legs.  The  sciatic  nerve  leaving  thru  the 
notch  in  the  ischium  may  become  irritated  in  a  lesion  of 
this  nature.  Sciatica  is  commonly  found  when  the  innomi- 
nate is  rotated.  The  sciatic  nerve  conveys  a  variety  of  im- 
pulses— vasomotor,  motor,  trophic,  etc.  This  nerve  is  also 


FIG.  9.     The  sympathetic  nerves  that  supply  the  various  organs  are  connected 
\\ith1  the  spinal  nerves  that  pass  out  from  the  spinal  cord  between  the  vertebrae. 


24 


POLIOMYELITIS 


well  vascularized.  The  lesion  mentioned  above  may  not 
only  cause  sciatica,  but  cold  feet,  muscular  atrophy,  swelling 
of  the  ankles,  and  many  other  symptoms. 

Add  to  this  condition  an  attack  of  infantile  paralysis 
and  we  have  a  complication  that  will  be  almost  impossible  to 
clear  up  unless  the  proper  adjustments  are  made. 

Thus  we  see  the  importance  of  making  careful  examina- 
tions of  children's  spines,  ribs,  hips  and  every  part  of  the 
framework  in  order  that  normal  impulses  may  be  maintained, 
and  when  an  epidemic  of  infantile  paralysis  attacks  the  chil- 
dren they  will  at  least  have  good  circulation  and  freedom  from 
nerve  pressure  to  withstand  the  invasion  of  toxins  that  takes 
place.  Their  chance  of  throwing  off  the  disease  and  clearing 
up  the  congestion  will  be  far  greater  if  nature  can  use  all  her 
forces  to  combat  the  disease. 


FIG.  10.     Most  attacks  of  infantile  paralysis  affect  one  or  more  of  the  extremities. 
The  nerves  involved  are  outlined  on  the  figures. 


CHAPTER  3 

APPLIED  ANATOMY— Continued 

Lymphatics  of  the  Head  and  Neck 

We  have  already  mentioned  that  the  most  direct  area 
of  infection  in  infantile  paralysis  is  through  the  membranes 
of  the  nose  and  throat.  The  virus  gains  entrance  during 
respiration  and  deglutition. 

We  have  also  referred  to  the  mode  of  infection  through 
the  alimentary  tract.  The  virus  is  carried  along  with  the 
bolus  of  food  and  enters  the  stomach.  During  the  process  of 
digestion  it  is  conveyed  to  the  intestinal  tract  and  the  system 
takes  up  the  virus  and  its  poisons  by  way  of  the  lacteals  and 
blood  channels. 

A  more  direct  infection  of  the  central  nervous  system 
may  take  place  thru  the  lymphatics  of  the  head  and  neck. 
The  membranes  of  the  nose,  naso-pharyngeal  region  and 
mouth  are  rich  in  lymphoid  tissue.  The  close  connection 
between  the  lymphatic  tissues  of  these  areas  and  those  found 
in  the  head  and  neck  allow  a  conveyance  of  the  virus  to  the 
membranes  of  the  brain  and  spinal  cord.  The  openings  for 
communication  are  numerous  and  the  paths  for  the  convey- 
ance of  infection  are  closely  connected.  The  superficial  and 
deep  lymphatic  vessels  and  nodes  found  in  the  neck  and 
throat  allow  of  ready  communication  and  transmission  of 
the  micro-organisms  and  their  toxic  products.  The  central 
nervous  system  may  be  almost  directly  invaded  by  the  virus 
found  in  the  membranes  and  lymphatics  of  the  naso-pharyn- 
geal region.  Once  the  virus  reaches  the  membranes  pro- 
tecting the  central  nervous  system  the  upward  invasion  to 
the  brain  from  the  cervical  region  is  readily  accomplished. 

The  cerebro-spinal  fluid  surrounding  the  cord  also  sup- 
plies the  area  around  the  brain.  There  is  a  communication 
between  the  cord  and  brain,  as  the  same  coverings  that  sur- 
round the  cord  are  continuous  with  those  covering  the  brain. 

One  of  the  most  noticeable  symptoms  in  an  acute  case 
of  infantile  paralysis  is  headache.  There  is  also  pain  in  the 
neck.  The  temperature  increases  in  a  typical  case  until  it 


26 


POLIOMYELITIS 


reaches  103°  or  a  trifle  more.  The  congestion  in  the  head 
and  neck  is  marked.  The  neck  seems  swollen;  the  lymph 
nodes  are  enlarged  and  indurated.  The  lymphatics  are  in- 
volved as  well  as  the  blood  vessels.  The  lymphatics  have 
carried  the  virus  to  the  hidden  membranes  of  the  central 
nervous  system. 

The  invasion  may  have  taken  the  route  found  in  the 
infundibular  region  and  the  cephalic  membranes  first  be- 
come infected.  The  virus  in  this  case  must  needs  travel 


FIG.  11A.     The  brain  is  well  supplied 
directly  from  the  heart. 


FIG.  11B.     Lymphatics  of  the  neck. 


APPLIED  ANATOMY 


27 


PLATE  G.  Anterior  view  of  the  cord  and  membranes.  1.  Posterior  horn;  2. 
Anterior  horn;  3.  Spinal  nerve  with  covering;  4.  Dura  mater;  5.  Turned  back;  6. 
Spinal  cord  bared;  7.  Arachnoid;  8.  Anterior  nerve  roots:  9,  10,  (top  no.)  Lat.  sur- 
face of  cord. 


28  POLIOMYELITIS 

downward  in  the  central  nervous  system  if  the  case  is  one 
that  is  not  abortive  in  type.  General  infection  of  the  cord 
may  or  may  not  take  place.  The  cephalic  membrane  in- 
volvement may  be  sufficient  to  cause  a  bulbar  paralysis 
which  will  eventually  affect  all  points  below  and  prove  fatal 
in  nature  if  sufficient  destruction  takes  place.  Again,  it  is 
the  amount  of  resistance  the  tissues  have  that  will  determine 
the  extent  of  the  destruction  in  the  nerve  cells.  The  lym- 
phatic engorgement  will  depend  upon  the  lack  of  freedom  of 
circulation  and  the  quality  of  the  blood  and  lymph. 

The  nodules  will  indurate  in  proportion  to  the  amount  of 
blockage.  The  more  regular  the  circulation  the  better  the 
oxygenation  of  the  blood  will  be,  and  good  blood,  well  areated, 
is  the  best  of  germicides. 

The  phagocytes  lose  their  potency  in  proportion  to  the 
amount  of  devitalized  tissues  they  have  to  work  in. 

The  extreme  amount  of  congestion  in  the  head  and  neck 
is  due  in  part  not  to  the  virulence  of  the  virus  as  much  as  to 
the  amount  of  obstruction  found  in  relation  to  the  blood  ves- 
sels and  lymph  channels. 

The  nodal  induration  is  much  more  rapid  when  the 
blood  circulation  is  impeded.  The  feverish  condition  of  the 
head  and  the  tendency  for  the  head  to  draw  backward  is  not 
so  much  a  question  of  the  effects  of  the  virus  and  its  toxins 
as  it  is  the  effect  upon  the  nerve  centres  thru  congestion  by 
obstructed  blood  and  lymph  channels. 

The  involvement  of  the  lymphatics  is  due  in  the  first 
place  to  the  more  ready  infection  and  conveyance  of  the  virus 
by  the  fact  that  the  tissues  in  which  these  vessels  are  found 
were  devitalized  by  obstructed  or  impeded  circulation. 

The  normal  tissues  in  the  pharyngeal  and  nasal  regions 
of  a  child  will  not  harbor  nor  convey  to  the  same  extent  the 
virus  as  in  the  case  of  a  child  in  which  adenoid  growths  and 
diseased  tonsils  are  found.  The  child  with  polypi  and  con- 
gested turbinate  processes  will  likewise  harbor  germs  and 
propagate  them  in  a  soil  that  is  suitable  for  germ  development 
thru  obstructed  lymph  and  blood  channels. 

The  cause  of  this  static  condition  in  the  sinuses  of  the 
head  and  the  membranes  lining  these  as  well  as  lining  the 
pharyngeal  region  may  be  due  to  a  variety  of  leisons.  There 
is  always  a  possibility  of  hereditary  weakening  or  diathesis 


APPLIED  ANATOMY 


PLATE  H.  Right  lateral  view  of  cord,  and  the  formation  of  spinal  nerves.  1. 
Anterior  horn;  2.  Posterior  horn;  3.  Anterior  median  fissure;  4.  Posterior  spinal  nerve 
roots;  5.  Lagamentum  denticulatum ;  6  and  8.  Dura  Mater;  7.  Posterior  ganglion. 


30  POLIOMYELITIS 

with  nervous  instability,  but  we  will  discuss  here  the  cause  in 
which  osseous  lesions  play  the  role  of  primary  factors. 

The  drainage  of  the  lymphatics  of  the  head  and  neck  is 
quite  the  same  in  both  sides.  Below  the  neck  and  for  the 
rest  of  the  body  we  find  a  vastly  different  proposition.  The 
lymphatics  of  both  sides  of  the  head  and  neck  tend  to  pass 
downward  to  a  common  collecting  centre  to  empty  into  the 
subclavian  veins.  The  superficial  communicate  with  the 
deep,  and  the  lymphatics  of  one  side  communicate  in  some 
instances  with  those  of  the  opposite  side.  Normally  the 
nodes  are  not  over-sensitive  unless  pressed  upon.  Induration 
is  pathological  if  found  to  any  extent.  The  same  rule  that 
governs  the  freedom  of  circulation  of  blood  is  more  or  less 
applicable  to  that  of  the  lymph  channels.  Lesions  that  con- 
tract muscular  tissue  will  obstruct  lymph  channels  the  same 
as  they  will  obstruct  the  blood  vessels.  Not  all  lymphatics 
have  vasomotors  supplying  them,  it  is  true,  but  there  are 
other  ways  of  obstructing  the  flow  of  lymph  and  blood  than 
thru  the  vasomotor  nerves.  The  lesions  mentioned  under 
the  heading  of  "cervical"  in  the  last  chapter  are  applicable  to 
the  lymph  channels  as  well  as  to  the  blood  vessels.  The 
lesions  that  produce  a  congested  condition  of  the  tonsils 
will  invariably  affect  the  lymphatics  that  are  so  abundant 
in  this  region.  The  lymphatic  tissues  that  form  the  outer 
and  inner  defences  of  the  naso-pharyngeal  region  suffer  ob- 
struction and  nodular  enlargement  whenever  there  is  venous 
stasis. 

The  involvement  of  the  membranes  of  the  sinuses  of  the 
head  are  either  secondarily  or  simultaneously  affected  thru  a 
vascular  disturbance  in  the  vault  of  the  pharynx  and  the 
region  of  the  nose. 

The  congestion  found  in  the  membranes  protecting  the 
central  nervous  system  are  the  effects  of  lymph  and  blood 
vessel  obstruction  thru  a  lesion  of  some  nature — osseous  or 
otherwise.  Before  congestion  there  must  be  obstruction, 
and  before  invasion  and  toxic  poisoning  from  virus  there 
must  be  a  suitable  soil  or  else  the  tissues  would  produce  an 
abortive  condition. 

Thus  we  see  first,  last  and  -always  the  greatest  preventa- 
tive  measure  in  infection  of  any  nature  will  be  the  mainte- 
nance of  normal  circulation  both  in  the  lymph  channels  and 


APPLIED  ANATOMY 


31 


PLATE  I.     Left  lateral  view  of  spinal  cord  and  membranes. 


32  POLIOMYELITIS 

in  the  blood  vessels.  This  accounts  for  the  numerous  cases 
of  the  abortive  type  of  infantile  paralysis,  and  also  the  noted 
fact  that  in  many  instances  only  one  or  possibly  two  in  a 
family  of  several  children  contract  the  contagion;  the  others 
go  along  uninfected. 

Fortunately,  the  microorganism  of  infantile  paralysis 
does  not  attack  children  as  numerically  as  the  germs  that  are 
connected  with  some  of  the  other  and  more  common  diseases. 
In  scarlet  fever,  measles,  whooping  cough,  etc.,  there  seems 
to  be  a  condition  that  makes  the  contagion  spread  with  a  more 
decided  virulence.  It  is  not  uncommon  to  see  these  children's 
diseases  go  right  thru  a  family. 

In  infantile  paralysis  the  central  nervous  system  is  di- 
rectly involved,  and  the  child  who  due  to  lowered  tissue 
resistance  from  spinal  lesions  and  other  conditions  furnishes 
the  most  suitable  tissue  soil  is  the  one  that  will  be  the  victim. 
The  others  may  have  the  germs  in  their  mucous  membranes, 
but  the  soil  is  not  favorable  to  infection  and  they  will  have 
simply  an  abortive  type  or  will  not  be  affected  in  the  least. 

The  obstruction  of  the  lymphatics  may  be  due  to  a 
secondary  condition.  The  presence  of  stasis  in  the  region 
of  the  tonsils  may  be  somewhat  chronic  in  nature.  There 
may  be  repeated  attacks  of  tonsilitis  which  may  last  only  a 
day  or  two.  The  disturbance  may  be  almost  wrholly  va? 
cular.  Should  the  obstruction  persist  and  the  lymph  nodes 
become  enlarged  there  will  be  a  lymphatic  involvement  that 
will  tend  to  complicate  matters.  Infection  will  be  a  natural 
sequence.  The  correction  of  an  atlas  or  axis  lesion  that  will 
remove  any  disturbance  to  the  superior  cervical  ganglion 
with  its  postganglionic  fibres  that  control  the  vasomotors 
to  that  region  where  stasis  has  been  present  will  re-establish 
normal  lymph  flow. 

Lymphatic  involvement  may  be  secondary  to  avaso- 
motor  disturbance  to  the  blood  vessels  in  the  same  region 
where  congestion  exists.  The  hyoid  bone  slightly  misplaced 
will  put  tension  upon  one  set  of  the  muscles  attached  to  it 
and  cause  not  only  venous  stasis  but  a  blocking  of  the  lymph 
channels,  and  as  a  result  we  will  note  nodular  enlargement 
in  the  lymphatic  chains.  The  enlargement  of  the  nodes  in 
the  region  of  the  mastoid  may  be  due  to  an  obstruction  of  the 
lymphatic  channels  in  the  region  of  the  clavicle.  The  back- 


APPLIED  ANATOMY 


33 


PLATE  J.     Posterior  view  of  spinal  cord. 


34 


POLIOMYELITIS 


ward  luxation  of  the  clavicle  with  a  subluxated  first  rib  may 
obstruct  the  drainage  of  the  lymph  into  the  subclavian  veins. 
The  middle  cervical  ganglion  may  be  involved  and  we 
may  have  a  thyroid  disturbance  as  well  as  cardiac  irregulari- 
ty thru  a  cervical  lesion.  This  may  in  turn  cause  pressure  by 
thyroid  enlargement  upon  the  lymph  channels  and  produce 
toxic  poisoning  of  the  membranes  and  tissues  in  the  throat , 
head  and  central  nervous  system. 


FIG.  12.     The  circulation  to  the  head.     The  veins  returning  the  blood  are  not 
shown,  but  parallel  the  arteries.     Note  the  formation  of  the  spinal  artery. 


APPLIED  ANATOMY  35 

The  presence  of  an  aneurysm  may,  thru  mechanical 
pressure,  cause  a  greater  disturbance  than  any  single  osseous 
lesion.  A  cervical  rib  may  cause  irritation  of  the  brachial 
plexus  and  the  sympathetic  system  that  will  not  be  relieved 
until  surgical  measures  are  used.  Not  all  disturbances  are 
from  osseous  lesions  in  the  way  of  vertebral  rotations  or  sub- 
luxations,  and  not  all  disturbances  are  from  local  interfer- 
ences. The  lymph  channels  may  be  affected  and  infected 
through  disorders  in  the  axillary  and  mammary  region,  or 
even  lower  down.  There  is  a  communication  between  the 
lymph  channels  of  the  thorax  and  cervical  region  back  of  the 
clavicles.  That  is  why  no  diagnosis  is  complete  that  does  not 
include  a  complete  systemic  survey  in  each  instance.  The 
high  temperature  of  a  child  or  an  adult  may  be  lowered  by  a 
single  adjustment  in  the  upper  thoracic,  or  a  similar  effect 
may  be  brought  about  through  the  correction  of  a  cervical 
lesion.  The  idea  is  to  determine  the  exciting  cause,  if  from  a 
lesion,  and  correct  the  irregularity  if  it  is  at  all  possible  to  do 
so. 


CHAPTER  4 

APPLIED  ANATOMY— Continued 

Lymphatics  of  the  Thorax  and  Abdomen 

Infection  almost  invariably  complicates  the  lymphatic 
system.  We  are  prone  to  think  only  of  the  veins  convey  ing- 
impure  blood  and  producing  congestion  and  stasis,  but  we 
must  remember  always  that  the  lymph  channels  are  the 
conveyors  of  toxic  products,  and  blockage  in  a  node  or  num- 
ber of  nodes  will  affect  the  elimination  or  retard  the  dis- 
semination of  toxic  products. 

There  is  a  possibility  of  the  virus  found  in  infantile 
paralysis  cases  entering  thru  the  bronchial  tubes  and  in- 
fecting the  tissues  in  relation  to  the  roots  of  the  lungs.  Dust 
particles  include,  germs,  and  their  entrance  via  the  bron- 
chioles may  cause  infection  and  enlargement  of  the  lymph 
nodes  in  that  area. 

There  is  a  possibility  of  the  virus  or  microorganisms 
of  infantile  paralysis  lodging  and  becoming  scattered  thru 
the  lymphatics  in  the  thoracic  region  in  relation  to  the  bron- 
chial terminations. 

Around  the  cord  the  pia  mater  and  arachnoid  harbor 
lymph  spaces.  These  spaces  are  in  communication  with 
the  vessels,  and  it  is  through  them  infection  enters  the  cord 
substance. 

In  the  abdomen  below  the  diaphragm  the  cisterni  chyli 
is  located.  Into  this  receptum  the  intestinal  lymphatic 
drainage  enters  and  the  beginning  of  the  thoracic  duct  is 
found.  This  duct  collects  from  the  abdominal  viscera  and 
pierces  the  diaphragm  in  relation  to  the  aorta. 

The  lacteals  carry  away  the  chyle  absorbed  from  the 
small  intestines  and  convey  the  substance  to  the  thoracic 
duct  that  passes  upwards  to  empty  into  the  subclavian  vein 
on  the  left  side. 

The  peritoneum  is  a  lymphatic  sac  in  one  respect.  The 
amount  of  absorption  that  takes  place  in  the  peritoneum  is 
great. 

The  food  taken  into  the  stomach  containing  the  micro- 
organisms of  infantile  paralysis  are  readily  absorbed  by  the 
lymph  channels  and  conveyed  to  the  blood  circulation. 


APPLIED  ANATOMY 


37 


PLATE  K.     Vascularization  of  the  central  nervous  system. 


38 


POLIOMYELITIS 


The  possibilities  of  mixed  infection  is  worthy  of  consid- 
eration. If  a  lymph  channel  is  already  infected  by  other 
germs,  it  is  in  no  condition  to  combat  the  virus  of  infantile 
paralysis  should  it  be  absorbed. 

The  lymphatic  system  is  in  danger  of  blockage  and  slug- 
gishness the  same  as  the  vascular  system.  The  normality 
of  the  nodes  and  channels  of  the  lymphatic  system  will  depend 
to  a  great  extent  upon  the  condition  of  the  blood  vessels  and 
the  tone  of  their  walls.  If  we  find  stasis  in  the  mesenteric 


FIG.  13.     Faint  view  of  the  nerves  involved  in  infantile  paralysis. 

blood  vessels  wre  are  likely  to  find  nodular  enlargement  of 
the  lymphatic  system.  The  numerous  nodes  found  in  the 
mesentery  and  along  the  vessels  of  the  bowels  are  normal 
only  so  long  as  the  blood  stream  to  and  from  the  abdominal 
viscera  is  normal.  A  diseased  organ  is  one  that  has  a  dis- 
turbed circulation  regardless  of  the  cause.  If  an  organ  is 
functioning  abnormally  we  invariably  find  its  vascular  sup- 
ply disturbed.  If  an  organ  is  mechanically  interfered  with 
we  also  find  the  circulation  to  that  organ  affected.  The 


APPLIED  ANATOMY  39 

cause  being  removed,  the  circulation  may  once  more  be  re- 
established. 

The  infection  of  an  organ  is  through  its  vascular  chan- 
nels, either  the  blood  or  the  lymph.  The  better  the  circula- 
tion the  less  chance  of  germ  invasion. 

The  more  perfect  the  assimilative  mechanism  the  less 
liable  the  virus  will  be  to  be  disseminated  and  propagated. 

Lymph  spaces  are  found  around  the  cord  in  all  regions. 
The  vascularization  of  the  cord  is  complete  at  every  segment. 
The  entrance  of  germs  at  any  point  is  possible.  The  nor- 
mality of  the  lymph  spaces  in  relation  to  the  pia  mater  will 
depend  to  a  great  extent  upon  the  normality  of  the  vascular 
system  in  relation  to  the  cord  and  its  membranes. 

If  there  exist  lesions  at  any  point  along  the  length  of  the 
cord  we  at  once  find  a  lowered  tissue  resistance  to  that  area 
of  the  cord. 

There  may  be  a  trophic  disturbance  or  a  vasomotor  insta- 
bility to  the  vessel  walls,  or  wre  may  find  stasis  from  a  con- 
tractured  musculature  that  will  block  the  lymph  spaces.  In 
any  of  these  conditions  the  tissue  vitality  will  be  under- 
mined and  invasion  is  more  apt  to  take  place. 

In  the  thoracic  region  we  may  find  costal  lesions  as  well 
as  vertebral.  The  relation  of  the  intercostal  vessels  to  the 
ribs  may  in  a  costal  subluxation  so  disturb  the  sympathetic 
ganglia  that  the  tissues  around  the  foramina  become  irritated, 
and  this  will  extend  into  the  cord  thru  the  blood  channels. 

The  blockage  of  one  vessel  to  the  cord  and  membranes 
may  so  lower  the  nerve  and  cell  integrity  that  a  cord  segment 
will  become  readily  infected  by  the  virus. 

Remember  that  the  cord  segments  and  their  cells  must 
be  kept  at  a  certain  tone  from  a  vascular  standpoint  or  else 
the  cells  will  not  functionate  normally.  In  the  ventral  por- 
tion of  the  grey  matter  of  the  cord  the  motor  cells  send  forth 
their  efferent  impulses,  and  the  muscular  tone  of  the  limbs 
will  depend  upon  the  normality  of  these  impulses  for  their 
strength  and  motion.  The  lowered  tone  thru  disturbed 
vascularization  plus  the  invasion  of  the  virus  or  its  toxins 
even  in  a  mild  or  abortive  case  will  cause  a  disturbance  to  the 
efferent  tracts  in  proportion  to  the  degree  in  which  the  cells 
resist  the  attack. 


40 


POLIOMYELITIS 


In  the  more  severe  cases  of  infantile  paralysis,  where 
exudation  accompanies  congestion,  we  note  a  marked  de- 
struction of  the  motor  area. 

If  the  spinal  arteries  and  veins  are  obstructed  to  any 
extent  the  lymph  spaces  are  occluded,  and  nature's  effort 
to  clear  the  condition  is  sorely  handicapped.  Thus  we  see  the 
prime  importance  of  keeping  a  child's  spinal  tissues  up  to  a 
normal  point  so  that  should  the  virus  gain  entrance  to  the 
body  there  will  not  be  lowered  tissue  resistance  in  the 
region  of  the  central  nervous  system. 

The  region  of  the  diaphragm,  with  its  many  openings 
for  the  passing  of  nerves,  vessels,  tubes,  etc.,  is  of  interest. 
The  presence  of  lower  rib  lesions  or  vertebral  misplacements 
may  so  affect  the  attachments  of  the  diaphragm  and  its  crura 


FIG.  14.     A  perfect  spine  has  no  lesions.     Every  section  moves  without  a  "  hitch . 
Notice  the  spinal  cord  does  not  extend  the  full  length  of  the  spinal  column. 


APPLIED  ANATOMY  41 

that  the  openings  found  in  its  central  tendon  and  in  the  region 
in  relation  to  the  vertebral  column  may  cause  undue  pressure 
or  obstruction  to  these  various  tubes,  vessels  and  nerves. 

The  veins  and  thoracic  duct  are  passing  upward;  the 
nerves,  aorta  and  esophagus  are  going  downward.  All 
have  their  functions  and  any  minor  obstruction  may  cause 
a  systemic  disturbance. 

The  thoracic  duct  has  a  few  valves  to  prevent  back- 
ward flow.  It  is  a  long  tube,  and  gravity  is  against  it  the 
same  as  in  the  saphenous  veins.  This  duct  has  its  vascular 
supply  and  nerve  tone,  although  it  has  not  the  marked  mus- 
cular tissue  within  its  walls  that  is  found  in  the  blood  vessel 
walls.  The  thoracic  duct  is  a  great  collecting  system,  and 
the  flow  of  lymph  must  be  emptied  into  the  veins  as  regu- 
larly as  possible. 

From  the  fact  that  the  lymphatic  system  has  to  deal 
with  toxic  products,  we  must  at  all  times  determine  the 
condition  of  this  duct  and  see  that  no  lesion  exists  that  will 
in  any  way  affect  its  walls  or  its  conveying  properties. 

The  cisterni  chyli  is  located  in  front  of  the  second  and 
third  lumbar  vertebrae.  Lesions  that  are  found  at  this 
region  or  even  higher,  including  lower  costal,  may  have  a 
marked  effect  upon  the  receptive  properties  of  this  collecting 
system. 

The  drainage  of  the  mesenteric  nodes  into  this  cistern 
will  depend  upon  the  normality  of  the  blood  vessel  circula- 
tion. The  presence  of  obstipation  with  poor  peristaltic 
action,  the  finding  of  adhesions  or  the  noting  of  growths 
and  thickening  of  the  tissues,  all  have  a  bearing  upon  the 
lymphatic  system.  Splanchnoptosic  conditions  will  affect 
drainage  and  obstruct  the  lymph  channels.  This  will  lower 
the  general  tone  of  the  tissues.  In  children  colic,  convul- 
sions and  constipation  will  lower  the  vitality. 

The  tissues  of  the  entire  body  in  the  child  are  not  only 
growing,  but  must  be  sustained  in  the  way  of  complete  nour- 
ishment as  well.  In  the  adult  the  growth  is  complete  and 
sustenance  alone  is  required.  The  activity  of  a  child  is 
much  greater  than  in  the  adult  as  a  rule.  The  resiliency  of 
the  tissues  is  greater,  and  its  bones  are  not  as  yet  com- 
pletely ossified.  It  takes  up  shock  better  than  an  adult,  and 
the  nerves  do  not  seem  to  suffer  from  accidents  as  do  those 
of  the  adult. 


42 


POLIOMYELITIS 


The  common  point  of  tissue  irritability  is  when  we  find  a 
lesion  from  a  fall  or  strain.  The  disturbance  to  the  vessels 
and  nerves,  unless  the  proper  adjustment  is  made,  will  con- 
tinue to  lower  tissue  resistance  thru  nerve  irritation.  If  the 
sympathetic  chain  is  involved  thru  its  connection  with  the 
spinal  nerves,  the  vasomotors  will  suffer  from  impeded  cir- 
culation, and  the  impulses  will  become  irregular. 

The  spine  of  a  child  from  the  time  it  is  born  must  be 
inspected  if  we  wish  to  keep  it  free  from  lesions  and  scoliosis. 
Some  children  grow  up  with  almost  perfectly  aligned  spines, 
while  others,  thru  traumatism,  suffer  irregularities  that  ad- 
justment alone  will  rectify. 


FIG.  15.  The  enlarged  sections  from  the  three  regions  of  the  spine,  show  the 
different  shapes  peculiar  to  each  region.  The  spinal  nerves  pass  through  the  openings 
back  of  the  solid  parts,  or  bodies,  of  the  vertebrae. 


CHAPTER  5 

TREATMENT 

Part  I 

To  outline  a  specific  course  to  pursue  in  treating  In- 
fantile Parah'sis  is  not  as  easy  a  matter  as  one  might  presume. 
In  the  first  place,  we  must  be  cognizant  of  the  fact  that  no 
two  doctors  have  the  same  viewpoint.  One  physician  may 
be  partial  to  accessories,  such  as  hydrotherapy  measures, 
while  another  may  be  inclined  to  emphasize  thermostatic 
agencies. 

Osteopathic  physicians  are  agreed  that  in  order  to  get 
the  best  results  in  these  cases,  we  must  stick  to  ten-finger 
Osteopathy.  That  measure  alone  will  get  the  best  results, 
and  we  must  remove  the  vertebral  lesions  if  one  or  more 
lesions  are  present.  The  Old  Doctor's  principles  are  true 
and  tried,  and  if  we  deviate  from  them  we  are  not  going  to 
secure  the  best  results. 

Few  cases,  if  any,  of  infantile  paralysis  are  without 
one  or  more  specific  spinal  lesions.  In  practice  we  have  yet 
to  find  a  case  without  a  specific  spinal  or  rib  lesion. 

In  our  clinic,  now  well  into  its  second  year,  we  average 
fifteen  a  day  three  times  a  week,  and  one-half  of  these  are 
infantile  paralysis  cases  in  the  chronic  stage.  Dr.  Gair,  in 


FIG.  16.  Section  of  the  spine.  A  vertebra  with  the  spinal  cord  and  its  mem- 
branes. The  small  cut  to  the  left  is  an  enlarged  section  of  the  cord.  Lymph  spaces 
are  found  in  this  area. 


44 


POLIOMYELITIS 


PLATE  L.     Braces  and   crutches  removed  by  osteopathic 
methods     (Author's  cases). 


TREATMENT  45 

her  famous  Brooklyn  clinic,  treats  thirty  and  forty  a  day, 
and  a  goodly  percentage  of  them  are  infantile  paralysis  cases. 

Strange  to  say,  some  of  our  osteopaths  have  not  secured 
good  results  from  treating  these  cases.  We  frankly  admit 
that  until  a  very  few  years  ago  we  did  not  get  good  results. 
We  now  know  why.  We  did  not  have  the  proper  vision. 
We  did  not  grasp  the  principles  laid  down  by  the  Old  Doctor. 
We  were  not  sufficiently  specific.  Our  technique  was  not 
right.  We  do  not  and  did  not  blame  Osteopathy.  We 
knew  that  we  were  not  following  along  the  right  path.  Now 
we  love  to  handle  these  cases,  and  we  get  good  results. 
Whether  it  is  a  recent  or  a  chronic  case,  the  results  are  in 
proportion  to  the  time  that  has  lapsed  since  the  attack  and  the 
seriousness  of  the  disease  at  that  time. 

There  is  only  one  royal  road  in  handling  these  cases, 
and  that  is  specific  adjustment.  Five  minutes'  time  is 
sufficiently  long  in  treating  a  patient,  and  sometimes  too 
long.  Ten  or  twelve  of  these  cases  an  hour  is  a  moderate 
record.  But  when  you  treat  them  don't  start  any  massage 
work.  That  is  not  our  work.  We  are  too  skilled  to  waste 
time  in  giving  massage.  Start  in  and  move  every  spinal 
joint.  That  takes  only  about  two  minutes.  Spring  the 
sacro-iliac  articulations  just  enough  to  get  motion.  Then 
give  a  specific  cervical  treatment.  Do  not  stop  to  relax  mus- 
cles in  a  child.  Adjust  as  rapidly  as  possible.  Make  every 
spinal  joint  yield  to  motion.  Spend  only  one  minute,  or 
possibly  two,  on  the  cervical  vertebrae.  So  far,  we  have 
consumed  four  minutes.  The  last  minute  we  loosen  up  the 
wrist  or  ankle,  according  to  the  extremities  that  are  involved. 

We  think  this  general  outline  of  treatment  for  chronic 
cases  will  be  approved  by  those  who  have  been  getting  the 
best  results.  Drs.  Gair,  De  Tienne,  Bernard,  Green,  Bush, 
etc.,  will  bear  me  out  in  these  statements.  Regarding  home 
treatment,  the  parent  or  guardian  should  be  instructed  in 
giving  massage  and  systematic  exercises.  Dr.  Bush  has  pos- 
sibly given  this  phase  more  attention  than  any  other  osteo- 
path. It  is  quite  necessary  to  have  our  specific  work  followed  up 
by  these  home  accessories  in  chronic  cases.  Usually  a  mother 
will  give  her  child  any  amount  of  home  drill  and  massage. 

As  already  stated,  massage  and  exercise  alone  will  sel- 
dom cure  a  chronic  case.  It  is  the  specific  work  that  counts. 


46  POLIOMYELITIS 

As  soon  as  we  get  away  from  Dr.  Still's  teachings  we    are 
going  to  fail  in  getting  the  best  results. 

Regarding  the  frequency  of  any  specific  lesion,  we  are 
unable  to  state  what  particular  lesion  or  lesions  are  most 
often  found.  Sufficient  is  it  to  make  a  careful  examina- 
tion, to  determine  the  number  and  nature  of  the  lesions,  and 
then  proceed  to  correct  them.  That  is  genuine  Osteopathy. 


FIG.  17.     The  spinal  cord  is  a  continuation  of  the  brain. 

"Find  it,  fix  it  and  leave  it  alone."  Five  minutes  of  thor- 
ough and  specific  spinal  adjustment  is  worth  hours  of  mas- 
sage or  even  muscle  manipulation. 

There  may  be  an  acceleration  of  the  blood  flow  after  a 
thorough  muscle  relaxation,  but  the  extremities  will  grow 
cold  a  few  minutes  after  you  are  through.  Give  a  good 
spinal  adjustment  from  the  atlas  to  the  coccyx,  and  note  the 
warmth  come  back  to  the  livid  muscles  and  the  disappear- 
ance of  the  flaccidity  and  the  regaining  of  tone  in  the  muscles. 
Muscular  atrophy  will  disappear,  and  the  limbs  will  once 


TREATMENT 


47 


more  round  out.  The  bones  will  start  to  lengthen,  and  the 
short  ones,  if  the  discrepancy  is  not  marked,  will  catch  up  in 
growth  with  those  that  are  normal. 

This  can  only  be  done  by  treating  the  nerve  centres,  those 
centres  which  have  to  do  with  motion  and  tissue  development, 
—the  motor,  trophic,  secretory  and  vaso-motor  centres. 


FIG.  18.     Nerve  impulses  travel  downward  from  the  brain  through  the  spinal 
cord  to  the  feet.     Paralysis  may  involve  a  part  or  all  of  a  tract. 

If  the  case  is  well  advanced,  that  is,  chronic  in  nature, 
and  the  motor  cells  have  been  destroyed  to  a  great  degree, 
we  must  bring  into  play  the  remaining  cells  of  the  cord  seg- 
ments that  will  co-ordinate  and  carry  on  the  reflex  arcs. 
The  viscero-motor  and  viscero-sensory  reflexes  must  be  re- 
established as  far  as  possible,  so  that  normal  tissue  tone  will 
again  be  regained  and  the  reflex  arcs  work  in  accordance  with 
physiological  principles. 

Every  cord  segment,  especially  the  cervical  and  lumbar 
enlargements,  must  be  constantly  bathed  with  good  rich 


48  POLIOMYELITIS 

blood.  We  must  get  good  vaso-motor  action,  as  that  alone 
will  restore  the  circulation  to  all  of  the  tissues.  If  the  slight- 
est subluxation,  costal  or  spinal,  exists,  we  cannot  expect 
good  results  until  adjustment  is  made. 

It  is  quite  unnecessary  to  tell  fellow  practitioners  how  to 
make  corrections.  We  simply  wrant  to  admonish  them  to  be 
careful  to  trace  out  these  lesions  and  to  be  specific  in  making 
adjustments. 

The  outline  of  treatment  thus  far  is  general,  we  admit, 
but  we  have  earnestly  sought  to  emphasize  the  keynote  of 
Osteopathy  as  applied  to  not  only  these  cases,  but  all  cases 
treated  by  our  own  peculiar  method. 

Acute  Cases 

The  treatment  given  in  acute  cases  is  unique.  We  knowr 
that  the  "  regulars, "  so  called,  state  that  cases  of  infantile 
paralysis  should  not  be  treated  or  massaged  for  several 
weeks.  Just  here  we  leave  the  trail  and  turn  to  the  right. 
True  it  is  that  we  have  been  handicapped  in  securing  acute 
cases,  especially  since  the  last  great  epidemic  in  1916.  But 
there  have  been  quite  a  number  treated  osteopathically  in 
the  acute  stage,  as  you  will  see  in  reading  the  case  reports 
contained  in  this  book,  and  the  results  have  been  most  satis- 
factory. We  thoroughly  believe  that  fifty  per  cent,  of  the 
cases  now  on  crutches  and  braces,  with  their  withered  limbs, 
would  be  in  an  almost  perfect  condition  physically  if  they 
had  received  osteopathic  treatment  from  the  very  first. 

The  treatment  may  not  have  necessarily  taken  more 
than  a  few  moments,  but  a  simple  adjustment,  or  even  inhi- 
bition, might  have  prevented  the  disastrous  condition  that 
resulted  by  following  the  medical  theory  that  they  should 
be  left  alone.  When  these  cases  are  left  alone  the  motor  cells 
literally  burn  up  and  are  destroyed. 

The  osteopath  is  fitted  by  training  to  handle  spinal 
cases,  and  just  such  cases  as  these.  Who  should  dictate  just 
when  spinal  treatment  should  be  applied  in  these  cases :  the 
osteopathic  doctor,  who  is  versed  in  this  particular  method, 
or  the  medical  doctor,  who  is  not  familiar  with  spinal  adjust- 
ment either  from  a  standpoint  of  etiology  or  from  a  standpoint 
of  physiological  reaction?  It  is  the  work  of  a  spinal  special- 


TREATMENT 


49 


ist,  who  is  familiar  with  the  control  of  the  circulation  by 
stimulation  and  inhibition  of  the  nerve  centers.  Case  after 
case  has  been  recorded  where  osteopathic  measures  had  been 
instituted  from  the  first  in  acute  cases,  and  almost  invariably 
the  results  have  been  all  that  could  be  expected. 

The  congested  cord  must  be  relieved.  The  circulation 
must  be  equalized,  and  how  else  could  it  be  accomplished 
save  through  the  scientific  application  of  nerve  centre  treat- 
ment. We  will  grant  that  the  medicos  are  right  in  saying 
that  massage  is  contraindicated,  but  Osteopathy  is  not  mas- 


FIG.  19.  At  birth  the  spinal  cord  is  almost  the  length  of  the  spine.  It  grad- 
ually shortens,  apparently,  as  the  spine  outgrows  it  until  at  about  three  the  cord  is  at  a 
level  of  the  second  lumbar  vertebrae. 

sage.  Leave  it  to  those  who  know  how  to  equalize  circula- 
tion, and  you  will  get  the  best  results. 

We  have  given  this  phase  particular  attention  and  know 
whereof  we  speak.  The  wrecks  all  over  the  land  following 
each  epidemic  are  proof  enough  that  the  proper  treatment 
was  not  given  in  the  acute  stage. 

Thousands  of  children  and  grown-ups,  following  the 
recent  and  far  past  epidemics,  are  living  examples  of  the 
fallacy  of  the  old  method  of  doing  nothing. 

No  specific  serum  has  been  found  that  will  cure  these 
cases  in  the  acute  stage.  Under  the  shadow  of  the  best 


50  POLIOMYELITIS 

equipped  laboratories  known  to  medicine,  the  last  great  epi- 
demic had  its  sway,  and  yet  look  at  the  cripples^— New  York 
is  full  of  them. 

Dr.  Gair  and  others  are  now  restoring  their  withered 
limbs  by  the  hundreds,  even  at  this  late  stage  of  chronicity. 
The  majority  would  never  have  become  cripples  if  osteopathic 
methods  had  been  instituted  from  the  beginning. 

We  have  tried  to  present  this  matter  in  the  true  light, 
and  we  only  trust  that  parents  will  become  sufficiently  in- 
formed so  that  should  another  epidemic  sweep  this  country 
in  a  few  years  the  children  will  be  spared  from  becoming 
helpless  cripples,  or  going  about  on  braces  and  crutches. 


TREATMENT 
Part  II 

A.  G.  WALMSLEY,  D.  O. 

In  Part  One  Dr.  Millard  has  emphasized  the  vertebral 
lesion  as  a  causative  factor  in  poliomyelitis  by  devoting  his 
remarks  on  treatment  to  the  necessity  of  correcting  all  spinal 
lesions  as  soon  as  it  is  possible  to  do  so. 

Before  passing  to  the  discussion  of  other  phases  of  treat- 
ment, we  wish  to  express  our  hearty  agreement  with  what  has 
been  said  regarding  spinal  lesions  and  spinal  treatment. 
There  is  no  doubt  that  the  splendid  record  made  by  osteo- 
paths in  treating  poliomyelitis  in  the  acute,  subacute  and 
chronic  stages  is  due  in  large  part  to  the  application  of  the 
principles  discovered  by  the  founder  of  Osteopathy.  There- 
fore, our  discussions  of  the  treatment  of  this  disease  must 
have  as  their  center  or  touchstone  the  principles  enunciated 
by  Dr.  A.  T.  Still. 

But  having  emphasized  the  prime  importance  of  the 
application  of  those  measures  peculiar  to  the  science  and 
practice  of  Osteopathy — namely,  spinal  adjustment — in  the 
treatment  of  poliomyelitis,  it  does  not  follow  that  the  treat- 
ment of  the  disease  ends  there.  Indeed,  we  are  cognizant 
of  the  fact  that  it  does  not  always  even  begin  there.  In 
some  acute  cases  of  poliomyelitis  the  tissues  are  so  exceed- 
ingly sensitive,  especially  the  spinal  tissues,  that  the  patient 


TREATMENT 


51 


will  not  tolerate  being  touched,  and  will  cry  out  if  he  thinks 
his  physician  or  his  nurse  is  going  to  touch  his  spine.  It  is 
at  once  apparent  that  in  such  cases  the  hypersensitive  con- 
dition of  the  spinal  tissues  must  be  relieved  before  the 
osteopath  can  adjust  spinal  lesions. 

It  is  fitting  that  we  should  mention  at  this  point  that 
parents  do  not — and  some  of  them  will  not — see  how  an 
osteopath  can  manage  these  very  sensitive  cases,  and  most 
M.  D.'s  hold  up  their  hands  in  horror  at  the  thought  of  an 
osteopath  being  called  to  see  such  cases.  But  what  does  the 


FIG.  20.  The  circulation  in  the  feet  is  supplied  by  the  far  away  heart,  small 
arteries,  etc.  Small  arteries  enter  the  long  bones  through  little  openings,  and  keep 
them  well  nourished. 


52  POLIOMYELITIS 

average  M.  D.  do  in  such  cases?  For  the  most  part,  his 
policy  is  one  of  hands  off.  The  disease  is  allowed  to  burn  it- 
self out,  and  in  many  cases  it  takes  the  patient  with  it;  and 
when  it  does  not  kill  the  patient  it  very  often  leaves  him  a 
hopeless  wreck.  It  is  true  that  the  M.  D.  resorts  to  internal 
medication  and  to  the  use  of  sera,  but  the  effects  of  such 
treatment  are  so  far  from  satisfactory  that  he  cannot  and 
(if  honest  with  himself)  does  not  look  with  any  degree  of 
hope  for  tangible  results. 

If  one  may  judge  from  the  host  of  children  with  withered 
limbs  and  misshapen  bodies  who  have  passed  through  the 
hands  of  the  medical  profession  in  recent  years,  one  cannot 
but  adjudge  the  medical  treatment  of  poliomyelitis  a  failure. 
In  the  face  of  these  failures,  one  may  be  permitted  to  ask: 
Why  should  the  medical  profession  say  this  should  not  be 
done;  that  should  not  be  done,  etc.,  etc.? 

We  are  unalterably  opposed  to  this  do  nothing  policy. 
We  believe  that  so  much  can  be  done  in  the  early  stages  of 
poliomyelitis  by  intelligent  handling  that  we  are  encouraged 
to  set  down  our  views  of  the  matter  in  the  sincere  hope  that 
they  may  prove  of  help  to  others  in  the  treatment  of  this 
disease. 

Procedure  in  Acute  Cases 

For  the  guidance  of  the  physician  we  will  outline  what 
we  consider  sane  and  logical  procedure  in  acute  poliomyelitis. 

FIRST — Isolate  the  case.  In  doing  this  the  patient 
should  be  put  in  the.  quietest,  most  cheerful — and  if  in  the 
hot  weather — in  the  coolest  room  in  the  house. 

SECOND — Keep  people  out  of  the  room;  none  but  the 
nurse  should  be  with  the  patient. 

THIRD — Stop  all  food.  When  we  say  all  food,  we  mean 
ALL.  This,  as  well  as  some  of  the  other  things  we  will  sug- 
gest, should  be  done  in  all  acute  infectious  diseases.  In  the 
acute  diseases  the  gastrointestinal  tract  is  utterly  unable  to 
carry  on  the  digestive  functions,  and  the  ingestion  of  food 
not  only  places  an  added  handicap  upon  nature  in  her  efforts 
to  clean  house,  but  it  also  prolongs  the  disease  and  makes 
more  probable  troublesome  sequelae.  Food  should  be  with- 
held until  the  temperature  is  down  to  100°  F.  or  lower.  When 
the  temperature  is  down  to  100°  F.  or  lower,  and  if  the  pain 
and  sensitiveness  have  practically  subsided,  feeding  may  be 


TREATMENT  53 

commenced  by  giving  fruit  juices  for  a  day  or  two;  then 
fresh  fruit  such  as  berries,  cherries,  oranges,  peaches,  or 
baked  apple  may  be  given.  After  a  day  or  two  of  this  the 
heavier  foods  may  gradually  be  introduced. 

FOURTH — In  acute  poliomyelitis,  as  in  all  fevers,  the 
patient  should  be  given  plenty  of  water  to  drink.  It  is 
better  to  give  a  little  at  a  time  and  give  it  often.  Water  to 
the  fevered  patient  is  both  food  and  drink.  It  literally 
helps  to  drown  the  fires  that  are  raging  within  and  it  pro- 
motes elimination. 


FIG.  21.  "Spinal  marrow"  is  really  the  spinal  cord,  with  its  three  coats,  as 
shown  in  the  small  section  to  the  right.  The  cord  seen  from  the  side  view  is  curved 
to  conform  with  the  shape  of  the  spine  which  encloses  it. 

FIFTH — In  many  of  the  acute  cases  the  spine  is  so  sensi- 
tive that  at  first  not  much  can  be  done  in  the  way  of  handling 
it.  When  we  encounter  such  cases,  shall  we  throw  up  our 
hands  and  say  that  nothing  can  be  done;  that  we  must  wait 
until  the  patient  has  improved  and  is  less  sensitive  to  the 
touch  before  attempting  spinal  adjustment?  Not  so!  We 
should  rather  do  all  that  may  be  done  to  get  the  patient  in 
such  condition  that  osteopathic  measures  may  be  applied. 
We  believe  that  the  best  way  to  accomplish  this  is  by  hydro- 
therapeutic  measures.  A  few  osteopaths  advocate  placing 
the  patient  in  a  bath  at  body  temperature  or  a  little  higher, 


54  POLIOMYELITIS 

and  keeping  him  there  for  fifteen  or  twenty  minutes,  this  to 
be  repeated  every  two  or  three  hours  until  contraindicated. 
While  we  believe  in  the  merits  of  this  procedure,  we  are  of 
the  opinion  that  hot  compresses  applied  to  the  spine  and  to 
other  very  sensitive  parts  will  answer  the  purpose  as  well  in 
most  cases  and  better  in  some  cases.  The  compresses  do 
not  require  that  the  patient  be  handled  as  much  as  in  putting 
him  in  the  bath,  and  this  in  an  important  consideration. 

In  applying  the  compresses  turn  the  patient  face  down 
upon  the  bed.  Place  one  or  two  cushions  under  the  abdomen. 
This  will  support  the  body  and  will  slightly  arch  the  spine. 
It  is  claimed  that  in  the  prone  posture  the  spinal  vessels 
drain  more  readily,  so  in  placing  the  patient  in  this  position 
to  apply  the  compresses  we  are  accomplishing  a  two-fold 
purpose.  The  compresses  should  be  applied  to  the  entire 
length  of  the  spinal  column,  but  special  attention  should  be 
given  to  the  more  sensitive  areas.  Light  compresses  should 
be  used  at  first  because  even  the  weight  of  a  light  compress 
may  not  be  well  borne  by  the  patient. 

The  first  two  or  three  compresses  should  be  warm  in 
order  to  accustom  the  patient  to  them.  After  that  they  may 
be  put  on  quite  hot  but  not  hot  enough  to  burn  the  patient. 
They  should  be  wrung  out  so  that  water  wrill  not  drip  from 
them.  The  application  of  the  hot  compresses  may  be  con- 
tinued for  one-half  to  three-quarters  of  an  hour.  This  pro- 
cedure should  be  repeated  in  two  or  three  hours  if  the 
patient  becomes  restless.  It  is  claimed  by  some  osteopaths 
that  when  the  patient  has  a  very  high  fever  cool  or  cold 
compresses  are  more  effective  than  hot  compresses.  In  such 
cases  it  might  be  well  to  try  cold  compresses.  The  com- 
presses help  to  bring  about  relaxation  of  the  tense  ligaments 
and  muscles  and  thus  promote  drainage  from  the  spinal  cord. 
The  compresses  do  more  than  this;  they  not  only  largely, 
sometimes  entirely,  overcome  the  painful,  sensitive  condition 
of  the  spinal  tissues,  but  they  also  have  a  decidedly  soothing 
effect  on  the  nerves  of  the  patient  and  as  a  result  the  patient 
is  enabled  to  rest  and  conserve  his  energies;  whereas,  he  had 
been  unable  to  rest  and  his  resistance  was  being  rapidly  de- 
pleted. 

We  are  of  the  opinion  that  not  many  applications  of  the 
compresses  will  be  necessary  before  the  osteopath  will  be 
able  to  do  gentle  corrective  work  to  the  spine. 


TREATMENT 


55 


SIXTH — Irrigate  the  colon  with  copious  saline  enemas. 
This  should  be  done  as  early  as  possible.  It  has  been  noted 
by  most  of  the  osteopaths  who  have  treated  acute  polio- 
myelitis that  not  only  is  there  a  decided  involvement  of  the 
digestive  tract,  but  that  the  fecal  discharges  are  very  of- 
fensive. The  sooner  the  colon  is  rid  of  the  offending  mater- 
ial the  sooner  will  the  fever  abate  and  the  other  symptoms 
subside. 


FIG.  22.     A  normal  spine  is  usually  found  in  a  person  with  a  normal  poise. 

At  first  the  colon  should  be  flushed  at  least  twice  a  day. 
In  some  of  the  more  severe  cases  the  colon  should  be  flushed 
every  five  or  six  hours  for  the  first  day  or  two.  Later  once 
a  day  will  do,  and  this  should  be  continued  so  long  as  the 
patient  is  bedfast.  When  the  patient  begins  to  take  solid 
food  the  bowels  should  be  closely  watched  until  normal 
action  is  restored. 


56 


POLIOMYELITIS 


PLATE  M.  "Intramural"  (within  the  walls).  1.  Dura  Mater;  2,  3,  and  4.  Per- 
iosteal  lining;  5.  Posterior  ganglion;  6.  Anterior  nerve  roots;  7.  Anterior  horn;  8.  Pos- 
terior horn;  9.  Anterior  median  fissure;  10.  Union  of  anterior  and  posterior  spinal 
nerve  roots.  11.  Ligamentum  denticulatum;  12.  Spinous  process;  13.  Ligament;  14. 
Body  of  vertebrae;  15.  Disc  between  vertebrae. 


TREATMENT  57 

SEVENTH — Close  attention  should  be  given  to  the  nose 
and  throat,  especially  where  there  is  profuse  discharge  from 
the  mucous  surfaces  of  these  parts.  The  nose  and  throat 
should  be  kept  as  clean  as  possible  without  undue  annoy- 
ance to  the  patient.  The  excretions  from  these  parts  should 
be  carefully  sterilized. 

EIGHTH — In  poliomyelitis  as  in  any  of  the  acute  dis- 
eases, it  will  be  found  that  the  feet  are  cold  even  though  the 
patient  is  in  a  high  fever.  This  is  true  even  in  the  hottest 
weather  in  summer.  A  hot  water  bottle  should  be  placed  in 
the  bed  but  it  should  not  be  allowed  to  come  in  contact  with 
the  feet  if  it  is  very  hot  lest  it  burn  them. 

Caution 

If  the  patient  makes  phenomenal  progress,  do  not  cease 
watchful  care  too  soon.  Relapses  have  occurred  where  the 
patient  was  allowed  too  much  exercise,  too  much  food  and 
too  much  excitement  when  it  was  thought  all  danger  was 
past. 

In  cases  that  at  first  show  only  slight  paralysis  and 
that  to  all  appearances  are  mild  cases,  it  is  well  to  be  as 
watchful  and  as  rigid  in  the  regime  outlined  as  with  the 
more  severe  cases.  The  only  safe  plan  to  follow  is  to  treat  all 
cases  of  poliomyelitis  as  though  they  were  severe  cases. 

When  the  acute  stage  is  past  and  convalescence  is  pro- 
gressing favorably,  it  is  still  imperative  that  great  care  be 
exercised.  The  osteopath  may  sometimes  wonder  why  a 
paralyzed  part  is  not  making  better  progress  under  treatment, 
and  may  be  inclined  to  chide  himself  or  his  science;  whereas, 
if  he  would  inquire  into  the  case  he  would  find  that  the 
patient  was  having  too  much  exercise  and  too  much  excite- 
ment. This  will  not  do.  Rest  and  quiet  are  indicated  if 
the  patient  is  to  make  a  satisfactory  recovery — a  recovery 
that  leaves  no  withered  limbs  nor  constitutional  weakness. 

In  cases  in  which  the  paralyzed  limb  or  limbs  have  not 
made  complete  recovery  within  a  few  months  from  the  onset 
of  the  disease,  the  osteopath  sometimes  questions  the  advisa- 
bility of  continuing  treatment.  We  believe  that  in  most 
cases  there  should  be  no  question  whatever  as  to  the  wisdom 
of  continuing  treatment. 


58 


POLIOMYELITIS 


Cases  will  sometimes  reach  a  point  where  it  would  seem 
that  all  has  been  done  that  may  be  done,  but  unless  complete 
recovery  has  taken  place  the  parents  should  be  encouraged 
to  continue  the  treatment  for  some  months.  Not  infre- 
quently when  this  course  is  pursued  one,  two  or  three  months 
the  patient's  condition  shows  a  decided  improvement  as 
compared  with  the  condition  when  it  was  thought  improve- 
ment had  come  to  a  standstill.  Furthermore,  the  osteopath 
should  not  base  his  conclusions  as  to  the  wisdom  of  continu- 
ing treatment  solely  on  the  condition  of  the  parts  paralyzed. 


T»0  Ktwtf*  w"n  ll"T»lf« 


Scrnoitt 


FIG.  23.  The  spine  is  made  up  of  sections  called  vertebrae.  Between  the  verte- 
brae pads  are  placed  to  cushion  the  spine.  Within  the  spinal  column  the  spinal  cord 
is  found.  The  cord  has  three  coats.  A  cross  section  is  shown  with  a  darkened  center. 
Part  of  this  center  is  the  motor  area  that  controls  the  muscles  and  is  found  damaged 
in  infantile  paralysis. 

In  a  child  whose  general  health  and  constitutional  condition 
was  much  below  par  prior  to  the  onset  of  an  attack  of  polio- 
myelitis, it  is  to  be  expected  that  nature  will  devote  some  at- 
tention to  rehabilitating  said  constitutional  condition,  and 
in  the  circumstances  she  can  not  give  all  her  energies  to  re- 
storing the  affected  limbs. 

Even  though  a  case  has  apparently  come  to  a  standstill  as 
far  as  progress  with  the  affected  limbs  is  concerned,  we  be- 


TREATMENT 


59 


lieve  it  unwise  to  discontinue  treatment  for  some  months 
later.  So  much  more  has  been  accomplished  for  many  of 
these  cases  than  the  osteopath  thought  could  be  accomplished 
that  it  is  well  to  give  the  patient  and  the  treatment  the  bene- 
fit of  any  doubt  that  may  exist  as  to  the  advisability  of  con- 
tinuing treatment. 


1R  '.*, 


m 


PLATE  N.     The  ligamentous  bands  that  hold  the  spine  together  and  fasten  the 
ribs  onto  the  vertebrae.     The  drawing  to  the  left  shows  them  removed  from  the  bones. 


CHAPTER  6 

Hints  to  the  Public  on  Infantile  Paralysis 

A.  G.  WALMSLEY,  D.  O. 

The  epidemics  of  infantile  paralysis  that  the  United 
States  and  Canada  have  witnessed  in  the  last  decade  or  so 
have  made  this  disease  appear  among  the  dread  possibilities 
of  each  summer  and  early  autumn  season.  In  addition  to 
the  epidemics  that  have  been  of  sufficient  severity  to  attract 
attention,  each  year  witnesses  sporadic  or  scattered  cases 
throughout  parts  of  the  country  not  included  in  the  epidemic 
areas. 

The  general  public  has  grasped  certain  facts  in  connection 
with  infantile  paralysis  more  readily  than  is  the  case  with 
most  diseases.  This  would  seem  to  be  due  to  the  nature 
of  the  disease;  to  the  fact  that  in  so  many  cases  it  leaves  one 
or  more  extremities  shrunken  and  lacking  normal  usefulness. 
And  this  again  emphasies  the  fact  that  perhaps  no  form  of 
illness  or  incapacity  attracts  the  public  eye  to  the  extent 
that  does  physical  deformity  and  inability  to  use  one's  body 
or  parts  of  it. 

But  from  the  standpoint  of  the  public,  several  questions 
present  themselves :  What  are  we  to  do?  Can  anything  be 
done  to  prevent  my  children  becoming  victims  of  infantile 
paralysis?  If  they  should  come  down  with  the  disease, 
what  is  the  best  thing  to  do? 

Prevention  should  be  the  watchword  of  all  intelligent  lay- 
men as  well  as  of  progressive  physicians.  But  in  order  to  pre- 
vent the  development  of  any  disease  we  must  have  some  grasp 
of  the  conditions  that  favor  or  make  for  its  development. 

Infantile  paralysis  is  classed  with  the  infectious  diseases. 
The  invading  germs,  it  is  claimed,  find  entrance  to  the  body 
through  the  mucosa  of  the  nasal  tract.  Medical  literature,  in 
discussing  the  cause  of  infantile  paralysis,  gives  practically  no 
space  to  any  other  factors  as  operating  to  cause  this  disease , 
holding  that  it  is  due  solely  to  germs.  With  this  view  we 
must  take  issue.  Observation  and  experience  have  shown 
that  a  number  of  things  predispose  to  and  favor  the  develop- 
ment of  infantile  paralysis  aside  altogether  from  the  part 


HINTS  TO  THE  PUBLIC 


61 


germs  may  play.  For  example,  in  many  of  the  children 
who  come  down  with  the  disease  there  is  a  distinct  history 
of  a  fall  or  injury  in  which  the  spine  is  affected,  this  dating 
from  a  few  days  to  a  few  weeks  prior  to  the  onset  of  the 
trouble.  On  examination  of  such  cases  it  has  not  been 
difficult  to  discover  spinal  irregularities  that  wrould  result 
from  such  accidents  as  mentioned.  Anything  that  will  inter- 
fere with  the  normal  relationship  of  the  bones  forming  the 
spinal  column  will  favor  the  development  of  infantile  paraly- 
sis, because  the  blood  supply  to  the  spinal  cord — and  to 


FIG.  24.  When  dressed  up  a  curvature  is  not  always  noticed  by  the  casual 
observer.  The  outline  of  the  spine  to  the  left,  is  also  a  front  view  and  tells  the  tale. 
Notice  the  drop  in  the  right  shoulder. 

certain  cells  of  the  cord,  which  cells  are  affected  in  infantile 
paralysis — is  interfered  with;  drainage  from  the  cord  is 
particularly  interfered  with  where  the  spine  has  been  strained 
or  injured,  because  even  a  slight  injury  causes  the  muscles 
to  contract,  and  this  through  pressure  on  the  vessels  impairs 
drainage  from  the  spinal  cord.  Where  drainage  from  the 
spinal  cord  is  impaired  the  poisons  contained  in  de-oxygen- 
ated or  venous  blood  are  not  removed  and  their  presence 
lowers  the  vitality  of  the  tissues  and  favors  the  onset  of 
inflammatory  conditions. 


62  POLIOMYELITIS 

Those  members  of  the  ostebpathic  profession  who  have 
studied  carefully  both  the  acute  and  later  stages  of  infantile 
paralysis  have  been  impressed  by  the  fact  that  almost 
invariably  there  is  a  derangement  of  the  alimentary  tract 
coincident  with  the  disease.  Not  only  is  there  a  loss  of 
desire  for  food,  but  when  the  colon  is  flushed  the  stools  are  of 
an  exceedingly  offensive  nature.  Is  it  unreasonable,  then, 
to  assume  that  a  filthy  intestinal  tract  lowers  the  resistance 
of  the  body  and  favors  the  development  of  the  disease? 
We  aver  that  it  is  not.  And  the  very  fact  that  colon  flushing 
early  in  the  disease  lowers  the  temperature  and  conduces  to 
the  general  comfort  of  the  patient  seems  sufficient  evidence 
that  the  contained  filth  played  a  part  in  causing  the  disease. 

But  why  do  so  many  children  as  well  as  adults  have  filthy 
intestinal  tracts,  and  why  are  so  many  taken  down  with 
intestinal  diseases  in  the  summer  months?  Because  there  is 
no  season  of  the  year  when  the  digestive  tract  is  bombarded 
with  such  a  quantity  and  such  a  variety  of  "eats"  as  in  the 
summer  and  early  autumn  months.  At  this  season  we  not 
only  have  the  usual  staples  as  meat,  potatoes,  bread  and 
butter,  milk,  cream,  pie,  cake,  puddings,  etc.,  but  we  also 
have  fresh  vegetables  of  all  kinds,  and  also  a  wide  range  of 
fresh  fruits.  Added  to  this  list  we  have  fruit,  pickles,  jams, 
etc.,  etc.,  that  mother  is  putting  up  for  winter.  And  super- 
added  to  the  above  we  are  confronted  with  ice  cream,  sodas, 
soft  drinks  and  candy,  candy,  candy  at  every  turn. 

Weigh  the  fact  that  owing  to  the  heat  of  summer  the 
body's  resistance  is  lowered;  also  weigh  the  fact  that  we  do 
not  require  the  same  quantities  of  heat  producing  foods  such 
as  fats,  sweets,  etc.,  in  the  hot  weather  as  in  winter;  and 
further,  weigh  the  fact  that  pathological  fermentation  takes 
place  more  readily  within  the  body,  just  as  foods,  fruits  and 
vegetables  ferment  or  spoil  more  readily  in  our  cellars  or  re- 
frigerators in  the  summer  months  than  in  cold  weather. 
When  these  facts  are  duly  weighed  and  the  added  fact  that 
at  no  time  of  the  year  is  the  alimentary  tract  invited  to 
sample  such  a  wide  variety  of  consumables,  is  it  any  wonder 
that  nature  so  often  rebels? 

The  mere  recounting  of  these  things  should  be  sufficient 
hint  to  the  wise  to  practice  moderation.  Cut  down  on  the 
heavy  foods  in  summer;  eat  more  fresh  fruits  and  fresh  vege- 
tables. Do  not  allow  your  children  to  be  constantly  guzzling 


HINTS  TO  THE  PUBLIC  63 

ice  cream  and  soft  drinks  and  eating  candy.  Never  mind  if 
some  wiseacre  says  that  "ice  cream  is  good,"  or  this  or  that 
is  good.  Many  a  thing  the  constituent  parts  of  which  are 
good  is  not  in  itself  good,  and  this  is  true  of  ice  cream,  soft 
drinks  and  candy  in  hot  weather;  a  little  is  all  right,  but  none 
but  the  strongest  can  take  these  things  daily  without  court- 
ing trouble. 

It  has  been  remarked  by  many  in  the  profession  that  an 
attack  of  infantile  paralysis  was  preceded  by  unusual  activity 
on  the  part  of  the  victim.  The  writer  frequently  has  had 
parents  call  attention  to  this  fact  and  cite  it  as  proof  that 
"Willie  was  unusually  well  just  before  the  attack."  How 
are  we  to  interpret  this  picture  of  unusual  activity  and  in- 
fantile paralysis  following  soon  after?  If  we  will  associate  a 
few  simple  facts,  facts  with  which  any  layman  is  familiar,  we 
should  find  a  solution  to  our  question. 

Is  it  necessary  to  call  attention  to  the  fact  that  the 
average  child  wears  as  little  clothing  as  possible  in  the 
summer?  The  child,  even  in  hot  weather,  is  irrepressible; 
he  will  romp  and  play  until  tired  out.  When  tired  what 
does  he  do?  He  lies  on  the  cool  grass  or  in  any  cool  place  he 
can  find.  And  wrhat,  under  such  conditions,  so  often  hap- 
pens? The  muscles  of  the  back  contract  and  the  back  feels 
stiff.  If  we  have  this  condition  plus  a  deranged  intestinal 
tract  as  outlined  above,  we  have  ideal  conditions  for  the  de- 
velopment of  infantile  paralysis.  The  contracted  muscles 
of  the  back  interfere  with  circulation  to  the  spinal  cord  and 
especially  with  drainage  from  the  cord,  and  favor  the  devel- 
opment of  infantile  paralysis.  The  writer  has  seen  quite  a 
number  of  cases  in  which  the  picture  presented  tallied  in 
every  respect.  When  we  consider  that  the  spinal  cord  of  the 
child  is  not  fully  developed  and  therefore  has  not  the  resist- 
ance of  that  of  the  adult,  are  not  the  conditions  enumerated 
sufficient  to  overtax  it  and  cause  trouble,  and  to  do  so  with- 
out the  introduction  into  the  system  of  germs?  And  if 
disease  germs  are  introduced  into  tissues  thus  weakened 
they  find  them  an  easy  prey. 

Parents  should  know  that  body  resistance  is  much 
lowered  when  the  weather  is  hot  and  humid.  Hot  weather 
in  itself  is  not  so  bad,  but  when  it  is  both  hot  and  humid  for 
weeks  at  a  time  there  invariably  is  an  increase  in  children's 
diseases,  and  particularly  in  those  diseases  in  which  the  ali- 
mentary tract  is  involved. 


64  POLIOMYELITIS 

During  the  epidemic  of  infantile  paralysis  in  and  about 
New  York  in  the  summer  of  1916  the  weather  was  exceedingly 
hot  and  humid  for  weeks,  and  it  is  worthy  of  note  that  as 
soon  as  it  began  to  cool  slightly  and  the  atmosphere  became 
drier  and  clearer  the  number  of  cases  reported  at  once  showed 
a  marked  falling  off.  In  such  weather  parents  should  pay 
close  attention  to  the  intestinal  tracts  of  their  children,  both 
in  the  matter  of  food  taken  and  in  the  matter  of  keeping  the 
bowels  clean.  Children  should  not  be  permitted  to  play  to 
the  point  of  physical  exhaustion,  and  they  should  be  kept  in- 
doors and  at  rest  for  an  hour  or  two  in  the  heat  of  the  day, 
and  especially  following  the  mid-day  meal. 

Finally,  if  children  are  taken  down  and  infantile  par- 
alysis is  suspected  or  a  positive  diagnosis  is  made,  the  vital 
question  is :  What  should  be  done?  Osteopathy  has  proved 
the  most  successful  treatment  to  date  for  infantile  paralysis 
in  both  the  acute  and  chronic  stages.  In  fact,  it  is  the  only 
known  treatment  that  is  able  to  cope  successfully  with  this 
disease.  If  the  child  is  so  ill  that  it  apparently  can  not  be 
touched,  do  not  be  afraid  to  call  an  osteopath.  If  a  preju- 
diced M.  D.  says  that  the  osteopath  "will  ruin  your  child," 
that  it  "will  surely  die  if  an  osteopath  treats  it,"  etc.,  etc., 
do  not  be  deterred.  The  osteopath  is  the  one  to  say  when 
osteopathic  procedure  is  indicated  and  when  not.  If  the 
average  M.  D.  were  asked  when  osteopathic  measures  were 
indicated  in  any  condition  he  would  almost  always  say 
never.  Why,  then,  should  the  public  expect  a  man  who  is 
prejudiced  against  all  forms"  of  treatment  but  his  own  to 
recommend  Osteopathy  for  infantile  paralysis  or  for  anything 
else? 

The  medical  profession  is  very  dogmatic  as  to  what 
should  and  what  should  not  be  done  during  the  acute  stage  of 
infantile  paralysis,  and  one  can  but  wonder  at  their  colossal 
conceit  when  one  contemplates  their  record  of  failure — abject 
failure — in  treating  this  disease.  The  osteopath  realizes 
that  he  does  not  know  all  that  is  to  be  known  about  infantile 
paralysis,  but  he  has  demonstrated  that  his  treatment  will 
will  do  more  for  it  than  anything  else  will  do.  And  what  is 
more,  it  has  been  fully,  indisputably  proven  that  the  earlier 
the  osteopath  gets  the  case  the  better  are  the  chances  for 
complete  recovery  of  the  use  of  paralyzed  parts  after  the 
acute  phase  of  the  disease  subsides. 


CHAPTER  7 

INFANTILE  PARALYSIS 

E.  FLORENCE  GAIR,  D.  O.,  Brooklyn,  N.  Y. 

While  a  student  at  the  American  School  of  Osteopathy 
I  became  greatly  interested  in  the  treatment  of  Infantile 
Paralysis,  and  I  decided  then  to  make  it  as  far  as  possible  a 
specialty,  or  my  hobby,  and  try  out  everything,  no  matter 
how  longstanding  or  how  bad !  In  the  class  room  I  had  been 
told  not  to  consider  a  case  after  two  years  from  the  attack 
and  to  seldom  give  prognosis  for  a  cure  after  six  months. 

I  started  my  clinical  work  in  the  Fall  of  '11  after  grad- 
uation in  June.  My  first  case  was  a  "dope"  case  I  had  to 
put  in  the  ward  of  a  private  sanitarium,  as  no  hospitals  are 
open  in  New  York  City  to  osteopathic  physicians.  While 
treating  this  case  another  woman  in  the  ward  told  me  of  an 
infantile  paralysis  case  just  dismissed  from  Rockefeller  Insti- 
tute as  a  hopeless  cripple,  and  asked  me  would  I  take  it? 

In  this  case  the  left  leg  hadn't  a  muscle  that  reacted  to 
stimuli;  it  hung  limp  from  the  thigh  down.  I  got  excellent 
results  in  a  short  time;  and  during  my  absence  at  Christmas 
time,  when  I  went  on  to  take  a  Post-graduate  course  at  the 
American  School  of  Osteopathy,  the  Rockefeller  Institute 
sent  for  my  case,  not  knowing  it  was  under  my  care.  The 
child's  walking  amazed  them  greatly.  Several  doctors  and 
nurses  gave  a  thorough  examination  with  all  the  tests.  I  was 
asked  on  my  return  to  call,  which  I  did,  and  Dr.  Draper  and 
I  had  a  long  talk  and  thoroughly  discussed  medical  versus 
osteopathic  treatment  for  this  disease.  As  he  was  in  charge 
of  the  wrard  for  infantile  paralysis  he  took  me  thru  and  showed 
me  his  cases.  One  case,  the  last,  was  being  left  entirely  to 
nature's  course,  to  see  the  result.  I  begged  him  to  take 
findings,  then  let  me  treat,  and  go  back  again  in  half  an  hour 
and  again  take  findings,  and  see  what  Osteopathy  would 
do  for  such  a  case.  Then  I  proposed  to  him  that  I  would 
give  so  much  time  there  and  we  would  each  take  a  certain 
number  of  cases  and  see  results,  or  else  he  would  send  me 
cases  after  his  examinations  and  keep  in  touch  with  each 


66 


POLIOMYELITIS 


case  every  month.  I  believe  fully  had  he  been  free  he  would 
have  complied  with  any  of  these  suggestions.  But  Dr. 
Flexner  was  in  charge  over  him,  and  there  was  the  barred 
door.  So  this  was  my  first  and  last  visit  to  the  Institute,  and 
I  fully  realized  how  little  such  an  institute  is  out  for  an  all- 
round  investigation.  It  must  come  only  within  certain 
prescribed  centres.  How  wrong  this  is,  only  the  unpreju- 
diced investigator  knows. 

This  first  case,  however,  brought  me  any  number  my 
first  year,  for  an  uncle  of  the  child  was  a  barber  in  Harlem, 


FIG.  25.     Dr.  Florence  Gair's  sanatorium  in  Brooklyn.     Dr.  Gair  has  the  largest 
infantile  paralysis  osteopathic  clinic  known. 

and  he  spread  the  news  broadcast.  The  little  girl's  father 
was  a  fireman,  and  he  likewise  spread  the  good  news,  so  that 
I  had  over  50  my  first  winter.  One  was  a  young  Jewess  of 
thirteen  who  had  been  in  double  braces  for  twelve  years,  her 
feet  in  plaster  off  and  on  for  the  past  two  years.  They  were 
swollen,  misshapen  and  horribly  discolored  from  impaired 
circulation.  She  had  such  a  bad  lumbar  curve  from  sec- 
ondary contractures  of  her  legs  that  she  walked  with  but- 
tocks swung  out  and  to  the  right,  shortening  her  stature 


INFANTILE  PARALYSIS 


67 


Considerably.  I  treated  the  case  twice  a  week  all  winter, 
with  very  gratifying  results.  The  curvature  straightened, 
and  the  secondary  contractures  left  the  limbs,  the  feet  be- 
came shapely;  the  swelling  all  disappeared  as  the  circulation 
was  restored;  and  today  she  walks  thirty  to  forty  blocks 
without  tiring.  The  first  time  I  insisted  on  her  discarding 
her  braces  she  could  only  go  a  few  steps  at  a  time  and  sit 


FIG.  26.  Dr.  Gair's  collection  of  braces,  casts,  etc.,  removed  from  infantile 
paralysis  cases  during  the  past  few  months.  Had  she  started  saving  them  from  the 
first,  she  would  not  be  able  to  put  them  in  one  cart  load. 

down  and  rest.  She  could  hardly  reach  the  car  in  front  of 
my  door,  and  had  to  rest  on  the  curbstone.  I  didn't  get  her 
for  treatment  after  the  first  winter,  as  she  felt  she  was 
cured.  The  right  leg  had  had  a  ham-string  tenotomy  per- 
formed, which  left  it  contracted,  so  never  was  as  good  as  the 
left  leg.  It  is  such  a  mistake  to  do  these  operations  before 
treating  the  case  and  watching  for  nature's  restorations  first. 


68 


POLIOMYELITIS 


There  is  time  enough  later  to  resort  to  the  knife,  plaster 
and  braces.  This  is  the  great  mistake  in  medical  treatment ; 
the  end  procedures  are  resorted  to  in  the  beginning  instead 
of  as  a  last  resort,  and  WHEN  is  THE  LAST  RESORT? 

I  was  greatly  interested  in  a  case  in  my  neighborhood 
which  was  stricken  in  the  '80's.  All  the  doctors  gave  up  the 
case,  but  the  mother  never  lost  hope.  She  massaged  and 
worked  hard  over  those  four  crippled  limbs  and  back.  It 


FIG.  27.     Last  winter's  case.     Back  of  both  legs  atrophied — now,  almost  com- 
pletely restored  (case  from  1916  epidemic). 

was  two  years  before  the  arms  were  of  use ;  it  was  four  years 
before  the  legs  returned;  and  eight  years  before  the  child 
really  walked.  But  today  she  is  the  mother  of  four  chil- 
dren, runs  her  own  auto,  skates  and  dances.  It  shows  that 
nature  needs  both  time  and,  in  many  cases,  assistance,  to  do 
her  work,  and  we  often  give  up  too  soon.  This  case  gave  me 
much  food  for  thought,  with  this  result :  in  my  seven  years  of 


INFANTILE  PARALYSIS 


69 


practice  I  have  never  resorted  to  an  operation  or  employed 
a  brace.  In  the  bad  spinal  cases  I  use  a  boned  corset  for 
support  if  the  spine  is  weak,  while  the  child  is  learning  to 
walk.  I  have  the  mothers  massage  and  rub  hot  oil  into  the 
affected  limbs  and  spinal  muscles — if  they  have  the  time, 
hot  salt  baths  and  exercises  against  resistance  at  first,  then 
overhead  bars  and  gymnastic  work,  acco  rding  to  the  case. 


FIG.  28.  (1916  epidemic)  Treated  last  winter.  Paralyzed  from  chin  to  toes. 
All  spinal  muscles  weakened,  as  well  as  both  arms  and  legs.  Fine  results,  as  you  see 
by  picture. 

FIG.  33.  This  winter  I  took  a  young  lad  of  eleven 
braced  most  up  to  his  chin  for  weakness  in  spine  and  legs — even 
a  worse  cripple  than  my  Jewish  girl  I  mentioned.  He'd  had 
the  attack  in  infancy.  His  back  was  badly  deformed  with  a 
mean  double  curve.  To  make  this  worse,  his  right  thigh 
was  so  badly  contracted  and  flexed  that  he  couldn't  sit  up, 
and  muscles  atrophied.  The  first  day  I  examined  the  case 


70 


POLIOMYELITIS 


it  looked  so  helpless  I  was  going  to  dismiss  it,  but  the  child 
begged  so  pitifully  and  said  he  knew  he'd  be  cured  if  I'd  just 
treat  him.  I  told  the  father  he  might  carry  him  to  me  for 
the  Sunday  clinic  and  I'd  try  him  out,  but  to  be  sure  to  keep 
off  the  braces.  He  came  the  latter  part  of  January,  and 
owing  to  the  inclement  weather  of  this  winter  made  many 
skips.  Still,  he  is  walking  today  on  one  crutch;  both  legs 
are  on  the  floor;  and  the  spine  has  lengthened  out  several 


FIG.  29.     Boy  age  3.     Same  boy  as  in  Fig.  36,  taken  one  year  later. 

inches.  He  sits  up  nicely  now  as  well.  The  atrophy  re- 
mains, but  the  contractures  have  all  disappeared  from  feet 
and  limbs.  All  he  says  now  is,  "  Didn't  I  tell  you  so?  I 
knew  I'd  get  well  under  the  right  treatment."  It  shows  me 
how  little  we  can  prognosticate  in  these  difficult  long-stand- 
ing cases.  I  find  nature  responds  so  quickly,  and  so  unex- 
pectedly, to  the  touch  of  the  right  button.  Our  motto: 
"Find  it,  fix  it,  leave  it  alone:"  How  fittingly  it  works  with 
nature! 


INFANTILE  PARALYSIS  71 

This  week,  (last  week  of  April,  1918),  I  had  a  two-year- 
old  baby  who  had  been  under  a  chiro  for  months.  He  had 
failed  to  touch  the  right  button  and  remove  a  bad  pelvic 
twist  on  the  lumbar.  This  had  caused  marked  contracture 
of  the  right  leg.  The  external  muscles  (the  thigh  rotators) 
had  twisted  the  thigh  and  the  post-tibial  group,  with  Achilles 
tendon,  had  made  the  foot  contract  to  bring  the  sole  upper- 
most. After  reducing  the  lumbar  lesion  Wednesday,  the 
rotators  of  the  thigh  gave  wTay,  and  the  leg  went  down  to 
normal  position.  After  stretching  the  foot  muscles — I  bound 
them  in  adhesive  plaster — I  found  this  morning,  three  days 
later,  a  marked  improvement.  The  foot  stayed  placed 
normally  on  the  table  writh  thighs  flexed.  No  atrophy  being 
present,  I  hope  to  get  nice  results  in  a  few  weeks  in  this  case. 

I  examined  a  bulbar  case  this  week  I  had  treated  last 
winter.  I  got  it  two  years  after  attack.  You  cannot  find  a 
trace  of  muscle  defect.  The  treatment  resulted  in  a  com- 
plete cure.  *' 

As  my  practice  is  entirely  confined  to  clinical  office  work, 
I  have  taken  very  few  acute  cases.  In  such  a  work  as  mine 
one  must  limit  one's  endeavors. 

My  earliest  infant  paralysis  case,  a  boy  of  three  years, 
was  seen  by  me  on  the  fourth  day  of  the  attack.  Three 
baby  specialists  had  seen  the  case,  and  had  agreed  that 
nothing  more  could  be  done  save  to  leave  the  limbs  swathed  in 
cotton  batting,  keep  the  child  warm  in  bed  on  his  back,  per- 
fectly quiet,  and  in  six  weeks  bring  him  for  electrical  treat- 
ment at  the  office. 

The  mother,  hearing  of  my  work,  rang  me  up  to  ask 
what  I  thought.  I  told  her  NOW  was  the  time  to  establish 
the  cure,  the  sooner  the  better.  I'd  undertake  the  case,  if 
I  might  have  full  charge  and  she  would  promise  no  inter- 
ference. When  I  saw  the  child  that  morning  he  was  lying 
a  helpless  mass  in  bed — paralysis  complete  on  right  side, 
including  the  face,  with  loss  of  speech,  the  right  side  of  the 
mouth  sagging  and  drooling  saliva. 

I  prepared  a  three-quart  enema,  and  with  my  metal 
sigmoid  colon  tube  I  administered  a  good  cleansing  of  the 
colon.  The  odor  from  the  bowel  was  a  stench,  showing  how 
necessary  it  is  to  thoroughly  cleanse  the  tract,  and  this  medi- 
cine will  never  accomplish.  Then  I  examined  him  for  lesions 


72  POLIOMYELITIS 

and  corrected  those  I  found  in  lumbar,  dorsal  and  cervical 
regions  of  the  spine.  This  took  about  ten  minutes.  I  had 
the  boy  put  back  to  bed.  I  told  the  mother  to  turn  him  on 
his  face,  and  let  the  spinal  cord  get  drainage,  which  would 
rest  him,  to  keep  him  warm  in  bed,  give  plenty  of  water,  but 
just  a  liquid  diet.  She  could  rub  the  affected  limbs  with  hot 
olive  oil,  but  not  for  more  than  fifteen  minutes,  and  also 
massage  his  back  muscles. 

I  'phoned  next  morning  and  heard  the  good  news  that 
the  arm  was  moving  and  speech  returning,  so  I  skipped  that 


FIG.  30.     The  description  of  this  case  in  the  text  is  most  interesting.     Note  the 
improvement  as  shown  in  case  31. 

day  and  went  the  following  afternoon.  I  found  motion  was 
coming  back  to  the  leg.  I  administered  the  same  treat- 
ment as  first  day  and  found  the  bowels  in  much  better  condi- 
tion. 

On  my  next  visit  the  following  day  I  found  full  motion 
restored  to  both  limbs  and  speech  nicely  returning.  What 
was  my  surprise  on  the  fifth  day  to  find  him  so  lively  that  I 
couldn't  catch  him  on  the  bed  to  treat  him.  He  ran  in  every 
direction. 


INFANTILE  PARALYSIS 


73 


It  was  a  balmy,  sunshiny  spring  day,  so  I  told  the  moth- 
er to  take  him  out  at  noon  each  day.  This  case  doesn't  show 
a  trace  of  the  disease  to-day.  Here  is  an  interesting  feature : 
He  caught  cold  in  the  next  ten  days,  and  had  a  relapse  with 
loss  of  speech  and  the  use  of  the  right  arm.  I  sent  him  to  Dr. 
DeTienne  for  these  treatments.  He  soon  had  him  well  again. 

The  M.  D.  formerly  in  charge  had  rung  up  to  learn 
how  the  boy  was  doing.  On  hearing  of  his  improvement, 
and  that  Dr.  Gair  was  in  charge,  he  told  the  mother  to  have  a 
care,  as  in  two  or  three  weeks  the  after  effects  would  be  worse. 


FIG.  31.     Same  as  case  30,  taken  a  few  weeks  later. 

It  was  hypnotism.  I  wasn't  a  " regular"  practitioner.  I 
had  no  diplomas.  I  was  just  a  quack.  The  mother  was 
frantic  and  rang  me  up  to  tell  me. 

My  next  earliest  case  was  brought  to  me  from  a  City 
Hospital  after  a  three  weeks'  stay.  (Both  these  cases  were 
before  the  1916  epidemic,  else  I  couldn't  have  seen  them  for 
from  six  to  eight  weeks.)  This  child  was  in  a  frightful  con- 
dition. The  nurse  had  left  a  water  bag  which  was  too  hot 
on  the  loin,  with  a  resulting  blister  which  became  infected. 
It  was  a  nasty  big  oozing  sore  when  I  saw  it.  The  child 
was  also  infected  with  a  nasty  coryza.  Her  stools  were  run- 


74 


POLIOMYELITIS 


ning  blood  and  both  ears  pus,  besides  the  paralysis.  It  was 
a  nasty  case  to  handle. 

In  two  weeks  I  had  her  walking  the  length  of  my  treat- 
ment table  after  pennies. 

The  bloody  stools  ceased  after  the  first  enema,  cleansing 
the  colon  and  reducing  the  lumbar  lesions,  putting  an  end 
to  that  trouble.  One  ear  cleared  up  in  a  few  days,  the  other 
ran  pus  for  over  two  weeks. 

The  healing  of  the  sore  was  likewise  of  long  duration. 
This  child  made  a  nice  recovery  by  the  end  of  that  winter. 


FIG.  32.     "Three  ambulance  calls  had  refused  to  take  him,  as  he  was  consid- 
ered too  far  gone."     He  now  rides  his  velocipede  for  hours. 

I  lost  track  of  these  cases,  as  the  poor  move  about  so 
much  from  one  spot  to  another,  and  I  haven't  seen  this  one 
since. 

The  winter  following  our  epidemic  brought  me  over  one 
hundred  and  seventeen  cases.  I  was  in  Seattle  during  that 
summer. 

From  October  onward  cases  in  all  stages  of  the  disease 
kept  coming  in.  It  was  very  interesting  to  watch  the  pro- 
gress of  the  different  cases.  Some  showed  no  signs  of  improve- 
ment for  six  months.  I  wondered  how  the  parents  kept  up 


INFANTILE  PARALYSIS 


75 


their  courage,  but  it  was  only  through  seeing  the  improvement 
in  the  others  and  hoping  that  their  child  in  the  end  would  get 
well.  One  little  fellow  was  brought  to  me  early  in  the  fall. 
Three  ambulance  calls  had  refused  to  take  him,  as  he  was 
considered  too  far  gone.  He  was  in  a  pitiful  plight,  stools 
running  blood,  rectum  paralyzed  and  protruding,  bad  leg 
and  spinal  paralysis,  with  a  horrible  coryza.  To  show  what 
a  nice  recovery  he  made,  I  have  taken  his  picture.  He  can 
run  about  now  on  his  velocipede  for  hours.  Fig.  32. 


FIG.  33.     This  boy  had  an  attack  of  infantile  paralysis  when  a  baby  and  was 
practically  helpless  when  taken  and  restored  to  the  condition  as  shown  in  the  picture. 

One  child,  not  three  years  old,  was  brought  on  a  stretch- 
er. Spine  too  weak  to  sit  up,  legs  both  paralyzed,  also  right 
arm.  I  had  her  walking  nicely  in  three  treatments.  This 
was  a  perfect  case.  Since  then  she  broke  her  arm  and  had 
wrist  drop.  I  was  fortunately  able  to  correct  this  deformity 
as  well. 

I  am  still  treating  a  little  boy  of  three.  The  home  town 
physician  said  he  must  be  operated  on  at  once.  The  right 
abdominal  muscles  were  paralyzed,  and  the  stomach  pro- 
truded out  like  a  small  balloon.  The  child's  right  leg  and 
arm  were  affected,  and  the  spinal  muscles  too  weak  to  give 


76 


POLIOMYELITIS 


support.  Today  he  is  walking,  the  leg  muscles  firm,  the 
atrophy  keeps  decreasing  and  he  has  two  nice  shapely  limbs. 
The  arm  is  perfect,  the  spine  is  still  a  little  weak,  and  to  pre- 
vent a  curvature  I  have  him  in  a  boned  corset.  The  ab- 
dominal muscles  have  gradually  regained  their  tone,  so  that 
there  is  is  now  no  protrusion.  In  another  year  the  spine,  I 
hope,  will  be  strong  and  able  to  do  its  work. 


FIG.  34.  Most  deformed  case  of  talipes  I  have  seen.  Foot  flexed  on  shaft  of 
tibia.  Heel  and  metatarsals  meeting.  Complete  muscular  atrophy  of  plantar  mus- 
cles. Boy  now  skates  with  rollers  and  on  the  ice. 

I  am  still  getting  cases  from  the  1916  epidemic,  that  had 
received  the  medical  treatment  for  two  years.  It  is  sur- 
prising to  see  the  quick  results  which  can  be  attained  in 
these  later  cases.  I  immediately  take  off  the  braces  and 
sometimes  wonder  what  would  indicate  their  use  in  cases  of 
babies  not  yet  walking. 

The  improvement  that  comes  from  reducing  a  spinal 
lesion  and  giving  the  limb  the  normal  blood  and  nerve  sup- 


INFANTILE  PARALYSIS 


77 


ply  is  often  astonishing.  A  flabby  useless  limb  will  tone 
up  in  less  than  a  month's  time.  Sometimes  the  improve- 
ment which  is  the  result  of  treatment  seems  hardly  credible. 
It  only  goes  to  show  how  responsive  nature  is,  if  we  only 
touch  the  right  button,  assist,  and  not  hinder. 

Sometimes  I  do  not  see  a  case  for  a  year  or  two  after 
the  treatments,  and  the  improvement  is  gratifying.  Many 
bulbar  type  cases  have  been  coming  in  of  late  to  let  me  see 


FIG.  35.     Bulbar  paralysis  on  right  side  of  face.     Complete  restoration.     Right 
arm  a  trifle  weak  at  deltoid  yet. 

the  cure.  You  can't  find  any  lack  of  tonicity.  Both  sides 
of  the  face  are  normally  balanced.  This  means  more  to  a 
girl  than  to  a  boy,  as  the  boy's  deformity  can  be  later  cov- 
ered up  with  a  beard  or  moustache.  Some  of  these  cases 
wrere  of  four  or  five  years'  standing  before  they  were  referred 
to  me,  this  making  the  cure  all  the  more  interesting  from 
the  standpoint  of  the  duration  of  the  paralysis. 


78  POLIOMYELITIS 

My  quickest  recovery  was  the  case  of  a  child  of  three, 
Fig.  30.  A  week  before  the  attack  she  had  fallen  down  the 
cellar  stairs.  It  was  Sunday  and  the  mother  had  returned 
from  Sunday  School.  She  noticed  a  sort  of  weakness  in  the 
child's  limb,  with  a  sudden  giving  way. 

Finding  the  child  had  lost  all  use  of  the  lower  limbs, 
she  quickly  prepared  a  hot  foot  tub,  with  mustard  added, 
into  which  she  put  the  child  while  she  ran  for  a  doctor.  The 
child,  for  the  next  three  months  was  confined  to  bed,  couldn't 
sit  up,  and  screamed  so  much  with  pain  that  narcotics  had 
to  be  administered.  The  mother  took  her  child  everywhere, 
seeking  a  cure.  Nine  surgeons  at  the  Long  Island  College 
Hospital  advised  an  operation  for  the  hip  joint.  In  the  mean- 
time the  mother  heard  of  me  at  her  office,  and  next  morning 
sent  the  child  to  my  clinic,  with  a  young  girl  who  cared  for 
it  in  the  mother's  absence.  I  adjusted  a  fourth  and  fifth 
lumbar.  The  child  sat  up  and  ate  her  evening  meal  for 
the  first  time  since  the  attack,  and  had  no  further  trouble. 
It  was  an  overnight  cure. 

The  M.  D.'s  termed  it  a  case  of  hypnosis  and  told  the 
mother  that  the  child's  condition  would  be  worse  when  the 
effects  wore  off.  She  has  only  a  slight  ptosis  of  left  eyelid, 
which  is  hardly  noticeable.  The  leg  doesn't  show  a  trace  of 
the  disease,  Fig.  31. 

In  getting  my  histories,  many  of  my  more  rapid  cures 
give  direct  histories  of  falls.  On  correcting  the  resultant 
lesion,  the  limb  was  quickly  restored  to  use. 

Most  of  my  cases  from  the  1916  epidemic  are  now  walk- 
ing nicely.  Some  get  well  quicker  than  others.  One  never 
can  tell,  on  examining  a  case,  how  it  will  turn  out.  The 
one  you  least  expect  results  from  often  proves  the  best  cure, 
and  vice  versa.  The  greatest  trouble  is,  we  give  up  too 
soon;  we  are  too  easily  discouraged. 

My  greatest  annoyance  is  interference  by  the  visiting 
medical  nurse  with  the  weak  parent.  She  returns  them  to 
medical  procedure,  they  go  back  to  the  brace,  to  the  cast,  or 
to  surgical  interference — and  the  poor  child  must  suffer! 

The  only  thing  I  resort  to  is  an  ankle  corset  and  a  boned 
waist  for  the  weak  spine.  This  can  be  taken  off  during  ex- 
ercise and  at  night.  I  like  elastic  sides  to  give  play  for  the 
ribs. 


INFANTILE  PARALYSIS  79 

I  encourage  mental  effort  in  all  exercise;  that  must  be 
secured.  Therefore,  exercises  against  resistance  are  the 
best.  I  keep  the  child  creeping  as  long  as  possible  while  the 
spine  remains  weak,  and  encourage  chinning,  and  work  on 
horizontal  bar  for  muscle  development.  Swimming  also  is 
fine — it  brings  all  the  muscles  into  play — likewise  the  Kiddie 
Kar,  the  tricycle  and  velocipede,  for  lower  limbs.  I  don't 
like  mechanical  electrical  machines  for  training,  for  this  does 


FIG.  36.  Same  case  as  Fig.  29.  Boy  two  years  old  when  this  picture  was  taken. 
Boy  at  left  had  legs,  arms  and  back  paralyzed.  He  now  wears  a  little  corset,  but 
walks  nicely. 

not  bring  the  cells  into  the  same  stimulus  as  personal  mental 
effort  in  the  training.  I  tell  most  of  the  children  they  can 
all  walk  if  they  only  want  to  hard  enough,  and  not  to  give  up 
too  soon  and  become  lazy. 

My  reason  for  objecting  to  the  cast  and  the  brace  is 
this:  the  disease  includes  the  motor  and  the  nutritional 
nerves.  As  soon  as  you  place  a  limb  in  plaster  you  decrease 


80  POLIOMYELITIS 

the  circulation  to  the  part  and  increase  the  atrophy,  and  you 
don't  get  the  desired  results.  The  brace  does  the  same 
thing.  It  is  heavy  for  the  weak  limb,  nearly  always  makes 
deformities  of  the  feet,  enlarges  the  ankle  bone,  and  causes 
nasty  sores  and  always  atrophy  and  muscular  weakness. 

Osteopathy  immediately  goes  to  the  centre  of  the 
trouble,  reduces  the  lesions,  giving  the  impaired  limb  a  better 
nerve  and  blood  supply,  reducing  the  contractures  of  old 
cases,  and  preventing  them  in  the  recent.  It  is  the  only 
logical,  sensible,  curative  treatment  for  this  disease. 


FIG.  37.    She  can  now  stand  on  her  lees  again.     I  expect  a  complete  cure. 


CHAPTER  8 

CASE  REPORTS 

L.  J.  BINGHAM,  D.  O.,  Ithaca,  N.  Y. 

Case  1. — Infantile  paralysis  in  a  boy  10  years  old;  called  October  16. 
1915,  on  the  sixth  day  after  initial  attack.  Patient  contracted  the  dis- 
ease in  the  country  on  a  hot  October  day  after  drawing  a  hand-sled  up  and 
down  the  road  and  other  strenuous  exercises  causing  extreme  fatigue. 
Case  reported  high  temperature  during  the  first  six  days;  temperature 
subsided  just  before  I  was  called.  I  found  the  following  picture:  Both 
legs  paralyzed,  left  one  slightly  worse  than  the  right.  Patient  was  unable 
to  lift  either  leg.  There  were  symptoms  of  extensive  inflamation  of  the 
spinal  cord  and  its  coverings,  with  typical  opisthotonos  simulating  spinal 
meningitis.  There  was  pain  in  the  legs,  the  back  muscles  and  the  back  of 
the  neck,  and  marked  tenderness  along  the  whole  spine.  The  patient  was 
constipated,  with  a  furred  tongue  and  poor  appetite.  The  bony  lesions 
present  were  a  twisted  fifth  lumbar  vertebra,  and  upper  cervical  lesions, 
thus  making  a  block  of  the  circulation  at  both  ends  of  the  spinal  cord. 
There  was  a  twisted  pelvis,  slight  curvature,  and  an  irregular  alignment  of 
ribs  and  vertebrae  at  points  all  along  the  back.  His  teeth  were  bad.  Mus- 
cles were  rigid  along  the  whole  spine.  Previous  to  the  attack  the  child  had 
been  notional  about  eating;  parents  indulged  him  with  sweet  foods  and 
things  he  liked.  Patient  responded  rapidly  to  treatment  from  the  first. 
The  diet  was  regulated,  constipation  relieved  by  enemata,  and  the  lesions 
reduced  as  rapidly  as  possible.  Treatment  was  given  twice  a  day  at  first, 
diminishing  until  finally  he  was  taking  only  one  treatment  a  week,  until 
May  13,  1916,  when  the  patient  was  discharged  in  good  condition.  He 
apparently  has  as  good  use  of  his  limbs  in  every  respect  as  he  ever  did. 

Case  2. — On  the  19th  of  October,  1916,  I  was  called  twenty  miles  in 
the  country  to  see  a  brother  and  sister  of  seven  and  nine,  respectively. 
These  children  had  been  constant  companions  of  a  neighboring  child  that 
died  of  infantile  paralysis  about  a  week  previous.  Both  children  came 
down  with  the  attack  the  day  before  I  was  called.  There  was  a  tempera- 
ture of  102,  together  with  the  usual  characteristic  sumptoms  of  an  acute 
attack  of  infantile  paralysis,  but  the  paralysis  had  not  yet  manifested  itself 

I  will  describe  how  I  handled  these  cases  and  thereby  give  my  methods 
of  treating  infantile  paralysis.  I  ordered  the  mother  to  discontinue  all 
food,  excepting  fruit  juices,  all  the  water  they  could  drink  and  concentrat- 


82 


POLIOMYELITIS 


ed  vegetable  broth  as  long  as  the  temparature  lasted.  The  broth  was 
prepared  by  grinding  equal  amounts  of  several  vegetables  through  a  food- 
cutter  and  boiling  this  pulp  for  three  hours,  afterwards  straining  out  the 
pulp  and  allowing  the  child  to  drink  the  broth.  I  ordered  an  enema 
morning  and  night,  a  cold  compress  about  the  neck,  and  a  daily  hot 
bath.  In  cases  where  there  is  evidence  of  inflamation  along  the  spinal 
cord,  a  cold,  wet  towel  is  put  over  the  area  and  kept  on  until  the  pain  and 
inflalmation  subsides;  rest  in  bed  and  treatments  two  or  three  times  a  day 
as  long  as  the  febrile  stage  lasts. 


FIG.  38.     Nerve  mechanism  down  thigh  disturbed  through  a  twisted  pelvis  and 
slight  spinal  curvature. 


CASE  REPORTS 


83 


There  were  well-defined  lesions  in  the  pelvic  and  cervical  regions.  The 
boy  had  a  slight  curvature.  I  corrected  these  lesions  as  best  I  could  on 
the  first  day.  I  stayed  several  hours  and  treated  two  or  three  times  before 
I  left.  The  mother  followed  my  instructions  carefully  for  a  week  before 
she  gave  any  solid  food.  The  little  girl  came  through  without  any  signs 
of  paralysis.  The  boy  had  a  slight  paralysis  of  one  leg  and  there  was  some 
paralysis  of  the  chest  muscles  which  interfered  somewhat  with  breathing. 
On  account  of  the  quarantine  laws  and  the  great  distance  from  town,  it 
was  several  weeks  before  I  got  to  treat  the  boy  again.  On  the  4th  of  De- 
cember the  child  was  brought  to  Ithaca  and  they  stayed  several  days.  He 


FIG.  39.     This  case  has  improved  under  treatment  so  remarkably  that  the  curva- 
ture has  been  almost  eradicated. 

then  had  a  slight  limp  and  his  curvature  was  increased  and  it  was  difficult 
for  him  to  take  a  full  breath.  I  treated  him  three  times  on  successive 
days.  Later,  he  was  brought  in  at  intervals  of  a  few  weeks  apart,  until  I 
had  given  the  child  seven  treatments.  This  case  made  rapid  improve- 
ment, the  limp  disappeared  and  the  breathing  and  curvature  improved. 
The  last  time  I  saw  the  case  I  could  -not  detect  any  muscle  deficiency  and 
the  boy  seemed  to  be  as  vigorous  as  before  the  attack. 

I  attribute  the  comparatively  mild  effect  on  these  two  children  to  the 
fact  that  I  saw  the  cases  early  and  gave  the  corrective  treatment  and  ob- 


84  POLIOMYELITIS 

tained  the  cooperation  of  the  mother  in  dieting  and  nursing  the  patients. 
I  believe  it  is  of  utmost  importance  that  food  be  withheld  from  infantile 
paralysis  patients  during  the  temperature  stage  and  that  every  effort  be 
made  to  eliminate  and  stop  the  production  of  toxins.  Cold  compresses 
placed  over  the  areas  of  the  cord  involved  are  a  great  benefit.  In  addition 
to  correcting  the  bony  lesions,  gentle,  general  relaxing  treatment  to  keep 
down  the  nervous  irritation,  aid  the  circulation,  and  to  promote  elimina- 
tion is  indicated.  I  believe  osteopathy  is  a  specific  for  infantile  paralysis 
if  it  is  applied  properly  and  early  enough.  Properly  graded  exercises  are 
important  in  helping  to  regenerate  muscles  and  restore  their  function  dur- 
ing the  later  stages  of  treatment. 


N.  GAYLORD  HUSK,  D.  O.,  Bradford,  Pennsylvania 

Case  3. — Boy  age  four.  Arm  and  leg  paralyzed,  unable  to  sit  up 
alone.  This  case  was  in  the  hospital  for  a  time  under  medical  treatment 
but  was  brought  home  as  hopeless,  the  physicians  saying  nothing  further 
could  be  done.  Under  osteopathic  treatment  he  began  to  improve  at  once 
and  continued  to  improve  steadily.  The  leg  has  been  restored  to  normal, 


FIG.  40.     Front  view  of  the  pelvis,  also  outlines  of  the  innominate  bone  when 
lesioned. 

and  the  arm  has  only  a  slight  impariment  of  function  when  raising  it  above 
the  head,  but  in  time  use  and  growth  will  rectify  this  slight  defect.  Fifty 
treatments  were  given. 

Case  4. — Boy  aged  two.  Leg  nearly  helpless,  could  not  stand  or 
walk  on  it,  only  slight  motion  of  foot.  Previous  to  the  attack  the  patient 
walked  normally.  After  a  few  treatments  improvement  was  noticed.  At 
first  there  was  marked  atrophy  but  this  is  greatly  improved.  This  boy 
can  now  walk  with  but  a  slight  "swing"  to  the  foot.  This  case  has  had 
fifty-one  treatments  to  date —  two  treatments  a  week  —  and  is  still  under 
treatment.  I  am  confident  this  case  will  be  restored  to  normal. 


CASE  REPORTS 


85 


L.  M.  BUSH,  D.  O.,  Jersey  City,  N.  J. 

Case  5. — A.  C.,  aged  9  months;  date  of  first  treatment  June  1,  1916. 
Previous  history,  bronchial  pneumonia  in  January,  not  well  since.  No 
history  of  fall  obtainable.  Four  brothers  and  sisters,  none  took  the  dis- 
ease though  exposed.  Present  illness :  About  May  7  child  indisposed  and 
slightly  feverish,  continued  irritable  for  two  or  three  days  before  it  was 
noticed  that  child  did  not  move  limbs.  M.  D.  called  and  case  diagnosed 
infantile  paralysis  but  merely  kept  under  observation.  No  particular 
medical  treatment  begun  and  parents  became  impatient  and  brought 
child  to  me.  Examination  showed  both  limbs  flaccid  and  completely 
paralyzed,  no  reflexes,  sensation  to  pain  normal  but  no  movement  even  of 
toes  when  foot  was  pinched  or  tickled.  Too  young  to  test  control  of  blad- 
der or  bowels.  General  appearance  irritable,  cried  when  limbs  were 
moved  or  when  they  were  washed  or  manipulated,  face  pale  and  thin,  no 
fever,  arms  normal. 

Spinal  lesions.  Second,  third  and  fourth  lumbar  vertebra  apparent- 
ly posterior  and  ligaments  tense  at  this  area. 


FIG.  41.  Relationship  of  the  spinal  cord  to  the  atlas  and  sacrum.  The  cord 
does  not  extend  as  far  down  as  the  sacrum,  but  spinal  nerves  pass  through  it  as  through 
a  sieve. 


86  POLIOMYELITIS 

Treatment.  Gentle  relaxation  of  lumbar  region  with  strong  flexion 
and  extension  and  stretching  same;  flexion,  extension  and  rotation  of 
thighs  to  obtain  free  motion  or  sacro-iliac  synchondroses  and  correct  les- 
ions; flexion  and  extension  of  knee  and  ankle  joints  to  prevent  anylosis  or 
fibrosis  and  some  manipulation  of  the  muscles  of  the  limbs  to  keep  up  cir- 
culation. After  a  week  the  child  began  to  move  the  toes  on  one  foot;  in 
two  weeks  could  move  ankle  and  toes  of  other  foot.  In  four  weeks  was 
able  to  flex  legs  and  thighs  weekly.  I  instructed  the  mother  to  exercise 
the  limbs  frequently  and  offer  some  resistance  to  movements  of  the  child. 
In  six  weeks  child  could  kick  quite  vigorously  and  move  the  foot  almost 
normally.  In  ten  weeks  tests  showed  that  there  was  full  return  of  normal 
muscular  action,  though  muscles  were  still  weak.  Child  continued  to 
gain  strength  and  started  to  walk  at  eighteen  months.  Child  also  gained 
five  pounds  in  first  ten  weeks'  treatment.  There  are  no  signs  of  the  par- 
alysis at  present. 

Case  6. — D.  H.,  age  4  years,  male,  August  1916. 

Previous  history.  Had  been  playing  with  two  children  in  same 
block  who  had  been  attacked  with  infantile  paralysis  the  previous  week. 
Weather  hot  and  very  humid  (see  note  below). 

Present  illness.  Child  appeared  tired,  cross  and  restless,  and  parents 
were  worried  because  other  cases  of  paralysis  had  started  the  same  way. 
Sent  for  me  as  a  precaution  as  this  was  in  the  midst  of  the  big  epidemic. 
Saw  child  at  9  p.  m.,  fever  of  103,  restless  and  irritable,  but  no  intestinal 
or  other  trouble  to  account  for  the  fever.  No  paralysis  yet.  Gave  treat- 
ment paying  special  attention  to  lumbar  region  of  spine :  there  was  a  mark- 
ed rotation  of  the  12th  dorsal  vertebra  on  the  1st  lumbar.  I  also  manip- 
ulated the  limbs  to  stimulate  reaction.  Visited  child  following  morning 
at  8  a.  m.,  fever  102,  still  restless  no  appetite,  but  no  symptoms  otherwise 
to  account  for  fever;  bowels  moving  but  lost  control  of  bladder.  No 
other  signs  of  paralysis.  Treated  similar  to  previous  time.  Saw  child 
again  at  8  p.  m.  and  found  temperature  100^,  child  seeming  better  but  still 
no  control  of  bladder.  Treated  twice  next  day  and  temperature  normal 
by  night.  Treated  following  day  and  child  felt  and  acted  fairly  normal 
except  for  paralysis  of  bladder.  Continued  treatment  for  three  weeks  be- 
fore child  regained  control  of  bladder.  In  this  case  only  paralysis  was  of 
bladder  but  due  to  the  history  of  exposure  and  manner  of  onset  I  feel  sure 
it  was  a  typical  case  of  infantile  paralysis,  and  I  mention  it  particularly 
because  I  was  called  probably  at  the  very  onset  of  the  fever  (mother  said 
he  seemed  to  have  none  two  hours  before  when  she  put  him  in  bed)  and 
the  frequent  treatments  broke  up  the  attack  as  an  attack  of  pneumonia 
is  frequently  aborted.  The  paralysis  of  the  bladder  would  seem  to  fur- 


CASE  REPORTS 


87 


ther  clinch  the  diagnosis.  I  did  not  call  in  consultation  as  the  scare  was 
so  great  I  knew  the  family  would  be  quarantined  and  the  child  removed 
where  I  could  not  treat  him,  to  an  isolation  hospital.  I  had  the  family 
observe  strict  quarantine  rules,  however. 

NOTE.  In  watching  the  epidemic  of  1916  here,  I  found  one  point  that 
seemed  to  throw  more  light  on  the  cause  of  infantile  paralysis  than  any 
other.  This  was  borne  out  later  by  weather  bureau  reports.  The  number 
of  cases  varied  directly  with  the  humidity  and  not  with  the  heat.  It  was 
worse  in  seacoast  towns  where  the  humidity  was  greatest.  The  epidemic 
began  to  wane  the  first  part  of  August  when  the  weather  became  clear, 
though  still  very  hot,  and  by  the  first  of  September  there  were  few  new 


FIG.  42.  Hand  everted.  Lesion  at  4th  cervical.  Case  cured  by  osteopathic 
adjustment. 

cases,  though  it  was  still  hot.  That  year  there  was  a  great  deal  of  cloudy 
weather  during  the  late  spring  and  early  summer  here  and  even  plant  life 
acted  in  a  peculiar  manner,  as  lettuce  rotted  in  the  fields,  beginning  at  the 
core;  many  other  vegetables  did  the  same  and  I  laid  it  to  the  lack  of  sun- 
shine and  continued  humidity,  as  when  the  weather  cleared  about  the  end 
of  the  first  week  of  August  both  the  paralysis  and  this  condition  of  the 
vegetable  kingdom  righted  themselves. 

Another  point  of  possible  value :  My  own  opinion  is,  that  if  a  germ 
is  the  immediate  exciting  cause  of  infantile  paralysis  it  is  a  widespread 
organism  like  the  pneumococcus  and  present  in  most  subjects  all  the  time; 


88  POLIOMYELITIS 

that  it  starts  the  general  infection,  just  as  the  pneumococcus,  when  through 
general  or  local  causes  the  resistance  of  the  individual  is  lowered.  Chil- 
dren being  the  weaker  and  less  matured  would  be  more  susceptible  because 
such  general  causes  as  humidity  and  excessive  heat  would  reduce  their 
resistance  faster  than  it  would  that  of  adults. 

In  several  cases  I  have  found  a  history  of  falls  and  believe  this  to  be 
predisposing,  allowing  the  infection  to  get  a  start.  In  practically  every 
case  I  have  had  there  have  been  other  children  in  the  family  and  none  got 
it.  I  believe  the  above  theory  explains  the  cases  where  more  than  one  in 
a  family  have  been  infected,  and  that  it  is  not  by  direct  infection. 


REGINALD  PLATT,  D.  O.  Minneapolis,  Minn. 

Case  7. — In  1910  there  were  four  cases  of  infantile  paralysis  among 
students  at  Princeton  University  that  were  admitted  to  the  University 
Infirmary  during  the  month  of  October.  Two  of  these  ran  a  very  short 
course  and  were  fatal,  the  diagnosis  not  being  made  until  autopsy.  Dr. 
Simon  Flexner  and  some  pathologists  from  Johns  Hopkins  were  in  consul- 
tation and  made  the  final  diagnosis.  Two  other  cases  dragged  along,  one 
under  treatment  as  typhoid  for  some  time,  was  taken  home  and  the  last  I 
heard,  rather  indirectly,  was  that  while  he  lived  he  was  so  badly  crippled 
that  his  return  to  the  university  was  given  up.  The  fourth  was  diag- 
nosed as  infantile  paralysis,  taken  home  and  did  not  return. 

At  the  opening  of  college  at  mid  September,  one  of  the  students  came 
to  me  for  treatment  for  constipation  and  some  trouble  with  his  heart.  He 
started  in  to  take  treatment  twice  a  week.  On  the  first  of  Novem- 
ber he  came  for  treatment  and  complained  of  feeling  out  of  sorts.  He 
had  had  a  bad  night  and  felt  nauseated  all  the  time.  Had  never  vomited 
in  his  life,  but  felt  now  that  vomitimg  would  relieve  him.  Upon  exam- 
ination of  the  spine,  I  found  the  musculature  of  the  splanchnic  region 
acutely  contractured  and  very  sensitive,  with  increased  rigidity  of  the 
vertebral  column.  He  had  tried  to  eat  breakfast  but  could  not.  Com- 
plained of  chilliness,  and  showed  temperature  of  100.5  degrees.  I  gave 
him  a  thoro  general  treatment,  specializing  a  little  on  neck  and  splanchnic 
regions,  sent  him  to  bed  with  instructions  to  eat  nothing,  drink  a  glass  of 
water  every  hour  and  apply  hot  water  bottle  to  the  splanchnic  portion  of 
the  spine.  I  kept  him  in  bed  for  two  days  and  treated  him  daily  for  four 
days,  at  the  end  of  which  time  he  seemed  normal.  Nausea  left  on  the 
third  day,  after  which  the  appetite  returned  and  I  concluded  that  the  case 
had  been  a  simple  indigestion. 


CASE  REPORTS  89 

The  following  Monday,  November  7,  he  came  to  my  office  to  obtain 
an  excuse  to  talk  to  the  Dean.  I  wrote  the  excuse  and  as  he  was  leaving 
the  room  he  remarked:  "What  do  you  suppose  is  the  matter  with  my 
right  leg?  It  doesn't  work  right."  I  made  an  examination  and  found 
that  the  calf  muscles  of  the  right  leg  were  partially  paralyzed.  He  lacked 
the  power  to  raise  the  heel  from  the  floor  while  walking.  There  was  a 
difference  in  the  tonicity  and  temperature  of  the  two  legb.  The  short 
flexors  seemed  to  be  somewhat  affected,  but  not  to  the  same  degree.  This 
paralytic  condition,  together  with  the  other  known  cases  in  the  infirmary, 
led  me  to  suspect  that  this  might  have  been  a  similar  case.  The  more  I 
thought  of  it,  the  more  the  idea  grew  upon  me.  On  November  16,  I  took 
the  patient  to  the  office  of  a  medical  doctor,  who  had  a  good  electrical 
apparatus  and  asked  him  to  make  the  tests  for  the  R.  D.,  and  after  doing 
so  he  gave  it  as  his  opinion  that  it  was  a  case  of  infantile  paralysis.  Short- 
ly after  this  the  uncle  of  the  patient  told  him  to  go  to  another  medical 
doctor,  who  was  a  particular  friend  of  the  uncle,  and  have  him  make  the 


FIG.  43.     Back  view  of  the  pelvis.     Relaxed  muscles  and  ligaments  in  infantile 
paralysis  sometimes  allow  this  condition  to  occur.     Spinal  curvature  is  the  result. 

electrical  test  (This  second  medical  doctor  was  very  bitter  against  the 
osteopaths.)  After  making  the  test  he  made  the  remark:  "I  guess  there 
is  no  doubt  that  you  had  infantile  paralysis,  but  it  must  have  been  a 
mighty  light  case." 

I  treated  the  case  regularly  three  times  a  week,  until  the  college  closed 
in  June,  and  at  that  time  there  was  very  little  difference  in  the  power  of 
the  two  legs.  The  one  affected  would  tire  more  quickly  than  the  other. 
When  he  came  back  to  college  in  September,  there  was  so  little  difference 
that  only  on  a  rather  severe  test  was  it  noticeable.  I  reported  the  case 
to  the  State  Board  of  Health  as  infantile  paralysis. 

Now  as  to  the  conclusions :  I  believe  the  case  to  have  been  infantile 
paralysis,  but  a  light  case.  There  were  at  least  two  factors  that  in  my 
opinion  contributed  to  the  mildness. 

1 .  The  few  treatments  received  prior  to  the  infection  were  directed 
to  the  area  involved  in  the  usual  cases  and,  no  doubt,  had  the  effect  of 
raising  the  resistance. 


90 


POLIOMYELITIS 


2.  He  was  under  treatment  from  the  very  first  symptom  of  any 
trouble,  said  treatment  being  directed  specifically  to  the  anatomical  lesions 
present.  The  absolute  rest  given  the  alimentary  tract  with  copious  water 
drinking,  favored  elimination. 

Another  factor  that  was  probably  as  powerful  as  any  other  was  the 
freedom  of  both  physician  and  patient  from  the  dread  which  a  diagnosis 
of  infantile  paralysis  would  very  likely  have  inspired. 

I  think  that  if  we  osteopaths  could  only  lose  sight  of  the  disease  as  an 
entity,  and  get  away  from  the  dire  prognoses  which  are  based  on  drug 
therapy,  we  would  take  an  immense  stride  forward.  Instead  of  treating 
the  disease,  treat  the  patient,  and  give  him  a  chance  to  live.  What 
might  have  been  the  outcome  of  the  above  case  if  I  had  been  handicapped 
with  a  diagnosis  of  infantile  paralysis  during  the  acute  stage,  is  hard  to 
imagine.  I  was  fresh  from  college  and  well  filled  with  the  ordinary  med- 


FIG.  44.     Curvature  is  always  accompanied  by  tilted  hips. 

ical  teachings,  and  just  as  liable  to  be  swamped  with  a  mere  name  as 
another.  I  have  often  thought  since  that  the  failure  to  make  a  diagno- 
sis was  the  luckiest  thing  that  ever  happened  to  that  patient. 

I  have  often  heard  osteopaths  caution  against  manipulating  the  spinal 
tissues  while  they  are  so  sensitive  in  the  acute  stage  of  infantile  paralysis. 
Fear  of  exciting  or  increasing  spinal  irritation  was  the  reason  advanced. 
In  almost  all  of  these  cases  the  pathology  of  the  nervous  system  develops 
very  early,  while  the  acute  symptoms  are  at  their  height.  This  stage 
sometimes  only  lasts  a  few  hours,  in  which  time  disastrous  results  have 
been  wrought  in  nerve  tissue.  After  the  acute  stage  is  over  the  return  of 
function  seems  to  vary  directly  with  the  time  that  elapses  before  osteo- 
pathic  treatment  is  instituted.  The  longer  the  elapsed  time,  the  slower 
the  improvement  and  the  less  of  it.  From  this  I  conclude  that  treatment 


CASE  REPORTS  91 

during  the  acute  stage  is  especially  indicated,  as  in  that  stage  the  path- 
ology is  developing.  If  we  can  resolve  a  certain  amount  of  pathology, 
after  its  establishment,  by  our  treatment,  directed  to  improve  the  circu- 
lation to  the  cord  tissue,  why  should  not  similar  treatment  have  been  a 
greater  benefit  when  given  at  the  time  when  the  pathology  is  in  the 
initiatory  stage? 

The  congestion  of  the  cord  in  the  early  stage  of  infantile  paralysis  can 
be  compared  to  the  congestion  of  the  lungs  at  the  beginning  of  a  lobar 
pneumonia.  In  the  latter  instance  there  is  plenty  of  good  evidence  that 
ostcopathic  treatment  will  reduce  the  congestion  and  normalize  the  cir- 
culation in  the  lungs  in  a  very  short  time.  (I  have  seen  it  done  in  less 
than  half  an  hour.)  If  the  congestion  progresses  to  consolidation  we  are 
confronted  with  a  pathology  different  in  nature,  and  the  resolution  re- 
quires more  time.  Still,  osteopathic  treatment  will  resolve  the  consolida- 


FIG.  45.     Spinal  curvature  not  only  produces  lack  of  symmetry,  but  interferes 
with  organs  and  tissues. 

tion  more  quickly  than  any  other  method.  The  pathology  of  infantile 
paralysis  practically  is  much  like  that  of  pneumonia,  viz:  an  intense  con- 
gestion followed  soon  by  a  degeneration  of  vessels  and  consequent  forma- 
tion of  hemorrhagic  foci  thruout  the  affected  portions  of  the  cord  tissue. 
We  all  know  what  a  clot  means  in  nervous  tissue.  We  all  know  that  the 
rule  is  that,  no  matter  how  soon  treatment  is  instituted  to  resolve  the  clot, 
the  restortation  of  function  is  never  complete.  Why,  then,  should  we 
hesitate  to  attempt  the  resolution  of  the  initial  congestion  before  the  clots 
are  formed?  In  the  lungs  we  have  the  freest  anastomosis  in  the  body; 
this  is  an  immense  aid  in  the  resolution  of  the  clot  in  pneumonia  and  is 
the  anatomic  reason  why  a  complete  restoration  of  function  is  had  in  the 
usual  recovery  of  pneumonia.  In  the  grey  matter  of  the  nervous  sys- 


92  POLIOMYELITIS 

tern  we  have  the  least  free  anastomosis  of  the  arterial  circulation;  hence 
the  lasting  loss  of  function  following  a  clot  in  this  locality. 

Everything  points  to  thoro  osteopathic  treatment  in  the  earliest 
stages  of  all  acute  diseases,  and  infantile  paralysis  would  seem  to  be  no 
exception  to  this  rule.  The  idea  of  waiting  until  the  acute  stage  is  over 
for  fear  of  producing  more  irritation,  seems  like  hesitating  to  drive  a 
mad  dog  away  from  biting  a  baby,  because  the  dog  might  not  like  to  leave. 


W.  A.  WOOD,  D.  O.,  Centralia,  Illinois. 

Case  8.— I  have  only  had  the  opportunity  of  treating  one  acute 
case  of  poliomyelitis.  In  November,  1912,  there  were  two  cases  in  a 
small  town  in  adjoining  houses,  one  patient  3  and  one  4  years  old.  I  was 
called  to  see  the  four-year-old  and  a  very  prominent  M.  D.  to  see  the  other. 
We  each  examined  and  consulted  together  on  both  cases.  He  said  there 
was  very  little  could  be  done  for  them.  I  treated  the  four-year-old  and  he 
treated  the  other  one.  The  doctor  made  very  light  of  me  when  I  gave 
him  my  prognosis.  The  result  now  is  that  the  case  I  treated  osteopath- 
ically  is  almost  as  sound  as  before.  Having  been  affected  in  both  legs  the 
right  leg  was  worse  than  the  left.  She  still  has  a  very  slight  limp,  hardly 
perceptible  to  one  not  especially  looking  for  it,  with  no  atrophy  of  muscles. 
The  M.  D.  finally  gave  the  other  case  up  as  hopeless;  told  the  mother  it 
would  always  remain  paralyzed,  which  it  has,  so  far,  with  the  muscles  bad- 
ly atrophied.  I  lay  my  success  in  this  case  to  the  spinal  treatment  during 
the  fever  stage,  which  assisted  in  reducing  inflammation. 


LYNETTE  BARTON,  D.  O.,  Bartlesville,  Oklahoma. 

Cases  9-10. — Several  cases  of  infantile  paralysis  came  under  my  care 
in  the  year  1913.  Most  of  them  came  in  the  month  of  June.  Without 
referring  to  my  books,  I  recall  thirteen  cases.  Probably  there  were  two  or 
three  more  that  I  have  forgotten.  One  case,  a  girl  aged  four,  died.  She 
had  been  treated  with  great  severity  by  a  chiropractor  previous  to  my 
visit.  Otherwise  I  think  she  might  have  recovered.  The  majority  of 
these  cases  were  referred  to  me  by  medical  doctors  thru  the  influence  of 
an  M.  D.  who  had  opportunity  to  observe  the  progress  of  a  similar  case  of 
his  own  that  had  been  brought  to  me  over  his  protest.  Of  these  thirteen 
cases,  seven  were  mild.  Four  of  the  seven  were  turned  over  to  me  as  soon 
as  the  fever  left  and  these  four  show  no  evidence  of  the  paralysis  to  the 
untrained  observer.  Of  these  four  the  minimum  of  treatment  administered 


CASE  REPORTS 


93 


to  one  patient  was  six  treatments.  The  maximum  to  one  patient  was 
twenty-four  treatments.  The  other  three  of  the  seven  mild  cases  were 
brought  to  me  at  periods  varying  from  three  to  six  weeks  after  the  onset. 
One,  a  boy  four  years  old,  had  never  entirely  lost  the  ability  to  walk. 
These  show  slight  atrophy  of  muscles  and  to  a  slight  degree  characteristic 
gait.  No  shortening.  No  contractures.  No  curvatures. 

One  severe  case  where  I  was  called  early  shows  less  evidence  of  the 
disease  than  the  milder  ones  that  came  under  treatment  late. 

In  three  of  these  thirteen  cases  the  lesion  was  in  the  cervical  enlarge- 
ment. It  is  difficult  to  get  babies  to  submit  to  neck  treatment. 
These  were  more  severe  than  most  of  those  showing  lumbar  cord  infec- 
tion, and  results  of  treatment  were  not  so  good. 

One  girl  of  1 1 — a  terrible  case — was  able  to  attend  school  the  follow- 
ing year.  She  shows  few  signs  of  the  disease,  but  her  arms  are  weak  and 


FIG.  46.  The  shortening  of  a  leg  following  an  attack  of  infantile  paralysis  pro- 
duces curvature  and  a  weakened  organism. 

she  has  to  wear  a  brace  to  prevent  curvature.  I  got  her  early.  The 
other  two  were  six  weeks  late.  The  cases  ranged  in  age  from  13  months 
to  1 1  years.  The  youngest  of  them  all  a  Polish  baby  whose  parents  could 
not  talk  to  me  without  an  interpreter — showed  consideralbe  atrophy  of  the 
gluteal  muscles  of  the  affected  side  after  four  or  five  treaments.  Both 
sides  were  alike  when  treatment  was  concluded.  This  nearly  always 
occurred  in  the  cases  that  came  to  me  early.  The  Polish  baby  was  the 
one  that  received  twenty-four  treatments  and  the  parents  wanted  me  to 
publish  the  cure  in  the  daily  papers  and  give  their  names  as  references. 

Treatment :  During  the  period  of  fever,  ice  packs  to  spine  or  ice  water 
sponging.  Ice  cap  to  head.  Extremely  gentle  inhibition  treatment  to 
spine  for  short  period,  once  or  twice  daily.  In  all  cases  massage  of  painful 
limb,  gently  given  for  short  periods,  with  olive  oil,  witch  hazel  and  al- 
cohol equal  parts. 


94  POLIOMYELITIS 

I  never  treat  a  case  of  infantile  paralysis  long  at  a  time.  After  the 
fever  is  past,  but  while  the  spine  is  still  sensitive,  I  use  gentleness  in  hand- 
ling. When  the  sensitiveness  has  vanished  I  treat  vigorously,  but  never 
long  at  a  time.  I  use  a  vibrator  close  under  the  heel  on  the  sole  of  foot 
of  the  affected  limb.  This  gets  vibration  on  the  long  bones  and  attached 
muscles  and  constitutes  about  the  only  local  treatment  given  limb.  I  do 
not  use  the  vibrator  on  the  back.  I  instruct  the  mother  to  rub  the 
affected  limb  for  three  minutes  twice  daily  with  a  compound  of  olive  oil, 
witch  hazel  and  alcohol,  and  to  sponge  the  spine,  limb  and  ankle  once 
daily  with  cold  salt  water. 

Things  to  guard  against:  Over-treatment  and  electrical  treatment. 
Medical  doctors  are  liable  to  insist  upon  both.  I  have  never  seen  any- 
thing but  harm  result  from  either,altho  this  may  or  may  not  be  permanent. 
I  advise  osteopathic  treatment  for  infantile  paralysis  without  delay.  In 
the  beginning  of  the  disease  two  weeks'  time  is  so  important.  I  treat 
three  times  a  week  the  first  month.  After  that  semi-weekly.  In  the 
cases  I  have  described  only  one  took  as  much  treatment  as  I  thought 
advisable.  Most  of  the  chronic  cases  that  come  late  for  treatment  should 
have  from  four  to  six  months'  treatment.  Rest  four  months  and  take 
three  more.  Then  two  months'  treatment  twice  a  year  for  a  few  years. 
Only  one  of  these  children  has  ever  needed  leg  braces. 


HARRY  W.  GAMBLE,  D.  O.,  Missouri  Valley,  Iowa. 

Case  11. — One  case  I  carried  thru  the  acute  stage  was  a  few  years 
ago.  I  made  an  early  drive,  eight  miles  on  Saturday,  and  found  a  boy  in  an 
alarming  condition.  His  father  asked  me  to  take  the  case  and  stay  on  the 
job  as  long  as  life  was  left  and  that  I  thought  I  could  do  good.  This  was 
a  very  malignant  type  and  I  was  greatly  worried,  along  with  all  the  fam- 
ily. Father  at  noon  told  me  they  were  satisfied  that  I  had  held  my  own 
which  the  medical  doctor  could  not  do,  but  if  I  wished  help  from  Omaha, 
Sioux  City  or  Council  Bluffs,  he  would  be  glad  to  wire  for  it.  I  told  him  I 
felt  I  was  doing  all  a  D.  O.  could  do,  and  wanted  no  help  of  that  kind, 
tho  I  wished  some  one  to  share  the  responsibility  with  me,  as  I  feared 
death  soon  in  the  case.  I  did  not  wish  to  call  an  M.  D.,  for  fear  he  would 
wish  to  dope  for  this  or  that,  and  I  expected  no  advantage  from  such  a 
course.  They  were  satisfied  with  my  work,  the  father  only  wished  to 
show  willingness  to  get  more  help  if  I  needed  it.  Ice  water  compresses 
to  spine,  with  thoro,  frequent  treatment  to  the  entire  spine  thruout  the 
day  and  much  of  the  night,  showed  decided  results  before  midnight;  coma 


CASE  REPORTS 


95 


and  delirium,  with  respiration  that  discounted  Cheyne-Stokes  type. 
Results  showed  osteopathy  could  deliver  the  goods.  The  boy  had 
not  been  very  strong  and  active,  but  paralysis  of  feet  and  legs  re- 
sponded daily  very  fast;  and  nutrition  and  motion  were  soon  perfectly  re- 
stored. I  stayed  all  day  Saturday,  from  before  daybreak,  until  about  2 
a.  m.  Sunday,  when  I  got  four  hours  sleep  and  the  boy  got  quite  a  little 
rest  at  this  time,  then,  getting  worse  again,  they  awakened  me,  when  I  got 
back  on  the  job  and  worked  almost  constantly:  I  would  treat  the  cervi- 
cals  for  opisthotonos  and  delirium;  fever  not  very  high;  massaged  legs 
after  treating  spine  thoroly,  as  they  were  cold  and  seemed  lifeless;  one 
arm  slightly  involved ;  worked  all  the  time,  as  ice  packs  to  spine  and  head 
did  good  when  I  did  not  treat.  By  Sunday  noon  he  seemed  like  another 
person.  It  was  phenomenal  how  he  responded,  and  after  dinner  I  went 


FIG.  47.     Brace  removed  six  years  after  an  attack  of  infantile  paralysis. 

home  and  returned  daily  for  a  week,  then  alternate  days  a  few  times, 
and  he  was  cured,  no  evidence  whatever  of  the  paralysis. 

I  have  carried  but  two  cases  of  infantile  paralysis  thru  the  acute 
stage,  but  have  had  several  others  under  my  care  after  convalescence,  to 
deal  with  the  paralytic  conditions.  None  need  have  misgivings  but  that 
osteopathy  can  and  does  deliver  the  goods  even  in  this  terrible  malady. 
The  first  case  I  had  about  ten  years  ago,  after  paralysis  involving  both 
legs  in  boy  ten  years  of  age  had  discouraged  the  M.  D.  in  charge  the  first 
few  days,  who  advised  that  there  was  little  hope  of  his  ever  walking  even 
if  the  patient  lived,  and  he  advised  osteopathy.  I  went  to  examine  and 
prognose  the  case,  and  was  given  full  charge  of  the  patient  Both  legs 
totally  paralyzed;  treatment  daily,  almost  entirely  to  spine.  Restored 
one  leg  to  perfect  use,  and  the  other  leg  gained  slowly  but  surely  for  six 
months.  Later  I  treated  but  once  weekly.  Not  a  toe  could  be  moved, 


96 


POLIOMYELITIS 


bowels  and  bladder  but  slightly  involved.  When  the  boy  quit  he  was  in 
better  health  than  ever,  and  can  now  skate,  or  ride  a  bike  very  decently, 
tho  considerable  atrophy  still  exists,  and  he  walks  with  considerable  swing 
and  limp.  His  brother  is  one  of  nine  from  this  community  now  at  A.  S.  O. 

I  have  been  called  in  to  play  second-fiddle  in  two  cases,  both  very 
low  for  a  week  before  they  called  me,  reaching  the  unconcsious  stage  and 
apparently  completely  paralyzed,  one  girl  age  ten,  they  gave  brandy  to, 
internally,  externally,  and  eternally,  but  I  could  not  agree  with  such  pro- 
cedure. Heart  about  160,  etc.,  and  I  only  treated  her  twice  during  the 
first  day,  she  dying  that  night. 

Cases  12-13. — Two  other  cases  that  I  stuttered  about  the  diagnosis 
of,  but  decided  finally  were  cerebro-spinal  meningitis,  recovered  fully. 


FIG.  48.     Well  developed  curvature  in  a  neglected  case. 

The  last  one,  boy,  nine  years  old,  had  a  homeopath  and  allopath,  and  was 
surely  dying,  had  he  contiuued  down  the  path.  He  called  for  the  osteo- 
path, both  in  delirium  and  when  conscious,  as  I  had  pulled  his  chum  thru 
a  year  ago  when  given  up  to  die  with  rheumatism  of  heart.  His  parents 
could  not  have  faith  in  osteopathy  when  both  M.  D.'s  could  not  control 
the  case,  and  they  feared  poliomyelitis,  so  they  thought  they  could  not  let 
him  die  without  granting  him  his  dying  wish  for  treatment. 

Bunting,  nothing  gives  me  the  gratification  and  downright  joy,  not 
to  add  respect  for  our  profession,  that  results  such  as  this  case  showed. 
Every  treatment  showed  decided  gain ;  so,  in  a  few  days,  he  was  out  of 
danger.  It  is  so  closely  related  to  poliomyelitis  that,  when  congestion  can 
be  so  wonderfully  controlled  in  meningitis  of  one  kind,  it  assures  me  equal- 
ly wonderful  results  can  be  had  in  any  other.  The  destruction  of  any  area 


CASE  REPORTS 


97 


must  make  allowances  for  results  expected.  Of  course  there  is  very  much 
that  I  don't  know  in  the  disease  you  ask  light  on,  but  I  have  given  you 
some  hints  that  may  serve  you.  Pure  ten-fingered  osteopathy  is  the  only 
type  found  in  this  community,  thank  God.  Am  heart  sick  after  just 
reading  reports  that  there  is  so  much  damnable  doping  by  pseudo  D.  O.'s 
going  on.  I'd  hang  or  ostracize  every  mixer  in  the  ranks  and  refuse 
license  to  every  such  person.  Drugging  is  rotten  enough  in  the  hands  of 
the  best  M.  D.  's. 

J.  W.  PAY,  D.  O.,  Milbank,  S.  D. 

Cases  14-15. — Four  years  ago  an  epidemic  passed  this  way  and  it 
was  my  fortune  to  have  seven  cases  to  care  for.     These  varied  from  the 


FIG.  49.     Neglected  cases. 

first  stages  to  paralysis  of  several  months'  standing.  The  cases  that  I  had 
from  the  beginning  made  the  best  showing  and  there  is  not  one  of  them  but 
what  is  walking  today.  The  two  cases  that  came  to  me  later,  after  re- 
ceiving the  regular  medical  treatment,  show  good  results,  all  improving 
greatly  under  treatment.  But  one  of  these  cases  will  be  crippled  in  one 
leg,  as  the  destruction  of  tissue  had  gone  too  far  before  the  case  came  to 
me. 

A  typical  case  in  a  two-year-old  boy  made  a  complete  recovery  in 
three  weeks'  time.  The  lower  limbs  were  affected  in  this  case. 

The  case  of  a  four-year-old  girl,  where  the  arm  on  the  right  side  and 
both  lower  limbs  were  affected,  recovered  completely  in  three  months. 


98  POLIOMYELITIS 

In  the  seven  cases  treated  all  have  been  restored  except  the  one  case 
mentioned,  and  all  show  normal  conditions:  so  I  should  say  osteopathy  is 
the  successful  treatment.  I  realize  seven  cases  is  not  sufficient  experience 
to  base  much  of  a  conclusion  upon,  yet  to  me  it  shows  that  we  are  able  to 
do  immeasurably  more  for  for  these  cases  than  the  old-time  treatment. 


MARGARET  E.  SCHRAMM,  D.  O.,  Chicago,  Illinois 

Case  16. — I  have  had  a  typical  case  of  infantile  paralysis,  which  I 
cured  in  two  months'  time.  Osteopathy's  success  was  stupendous!  Three 
medical  doctors  had  given  up  the  case  as  hopeless  before  I  took  it.  Osteo- 
pathy was  employed  as  a  last  resort.  My  little  patient's  mother  took 
care  of  her  baby  in  the  most  intelligent  and  conscientious  manner,  with- 
out which  all  osteopathic  treatments  must  have  come  to  naught. 

Three  years  ago  I  was  called  to  attend  a  baby  girl  nine  months  of  age. 
She  had  been  a  healthy,  normal  and  mentally  bright  baby  before  being 
stricken.  When  I  first  saw  her  both  of  her  lower  limbs  and  one  arm  were 
paralyzed ;  flexor  and  adductor  muscles  were  contractured ;  her  eyes  were 
of  a  leaden  hue  and  her  temperature  was  subnormal.  Was  a  bottle-fed 
infant.  I  was  properly  frightened  at  the  sight  of  a  child  so  nearly  dead ; 
however,  I  was  determined  to  give  osteopathy  the  usual  good  try  out. 
The  first  time  I  treated  the  baby  w&s  late  at  night.  That  was  on  the  first 
day  of  the  month.  The  next  day  I  treated  her  twice  (early  and  late) ;  after 
that  once  a  day  up  to  the  7th  of  the  month,  when  I  began  to  treat  every 
other  day.  My  first  treatments  lasted  four  minutes  and  were  directed  to 
the  spine  only  (greatest  tension  in  upper  dorsal  area).  Gradually  the 
treatments  were  made  more  general,  lasting  about  ten  minutes.  My  little 
patient  got  her  first  ten  treatments  at  home  and  then  sixteen  treatments 
more  at  the  office  a  few  blocks  from  her  home.  Twenty-six  treatments 
did  the  work.  All  the  functions  of  her  body  have  been  restored  and  the 
child  has  en  joyed  perfect  health  ever  since.  The  only  adjunct  to  osteo- 
pathy employed  was  a  tepid  bath  daily,  followed  by  an  olive  oil  rub  and 
the  taking  of  half  a  teaspoonful  of  olive  oil  daily.  We  had  no  trouble  with 
the  bowels  of  the  patient.  We  did  not  dress  the  baby  after  her  bath,  but 
wrapped  her  in  a  soft  flannel  blanket  and  let  her  take  her  morning's  nap. 
After  the  nap  she  was  dressed  and  taken  for  an  outing.  This  happened 
in  early  autumn,  but  the  outings  were  adhered  to  rigidly. 

When  I  first  treated  the  baby  she  cried  violently  and  fought  against 
it  with  all  her  might;  that  ma/le  me  think  that  I  was  hurting  her;  however, 
a  little  incident  proved  to  me  that  pain  was  not  the  cause  of  her  rebellion. 


CASE  REPORTS 


99 


The  baby's  mother  found  it  necessary  to  leave  her  charge  for  a  week  in 
order  to  recuperate  her  strength.  The  child  was  left  in  the  care  of  a 
stranger.  I  called  at  the  house  again  because  it  simplified  matters  for  the 
nurse.  When  I  came  to  treat  the  little  one  (this  was  probably  at  the  end 
of  the  first  month)  she  was  delighted  to  see  me,  because  she  knew  me  bet- 
ter than  her  nurse.  From  then  on  her  treatments  seemed  to  be  pleasant 
or  even  entertaining  to  her.  We  have  been  friends  ever  since.  No  doubt 
i  lit-  baby  had  been  spoiled  in  spite  of  all  efforts  on  the  part  of  the  mother 
to  control  the  situation.  The  little  one  had  developed  a  habit  of  being 
awake  at  night  and  to  sleep,  whenever  she  did  sleep,  in  the  daytime.  She 


FIG.  50.     Case  restored  to  normal  by  osteopathic  treatment. 

overcame  this  habit  in  six  weeks.  It  must  be  considered  that  the  child 
suffered  desperately  for  three  months  before  I  took  the  case,  passing  thru 
all  the  stages  of  the  disease. 


A.  J.  BROWN,  D.  O.,  San  Antonio,  Texas 

Case  17. — History  of  case  of  infantile  paralysis,  November,  1913. 
Children  of  Mr.  and  Mrs.  Persons,  Bay  City,  Texas.  Girl,  aged  3  years, 
stricken  on  Wednesday,  died  on  Sunday.  The  boy,  aged  20  months,  was 
stricken  the  following  Wednesday.  The  fever  lasted  about  a  week,  result- 
ing in  complete  paralysis,  even  to  all  muscles  of  the  neck  and  to  the  upper 
eyelids.  The  child  was  taken  to  the  leading  physicians  in  Houston  and 


100 


POLIOMYELITIS 


San  Antonio,  but  no  hope  of  recovery  was  given  by  them.  The  child  was 
brought  to  me  about  two  weeks  after  being  stricken.  I  gave  him  daily 
treatments  with  the  following  results:  After  the  second  treatment,  nor- 
mal movement  of  the  bowels  and  kidneys.  End  of  first  week,  eye  and 
neck  improvement  well  marked.  Second  week  marked  improvement  in 
all  the  limbs;  third  week,  could  turn  and  roll  over  on  bed;  fourth  week, 
could  stand  on  feet  with  a  little  help,  and  from  that  on  improvement  was 
fast  until  complete  recovery  was  effected.  I  treated  him  daily  from  Nov. 
20  to  Jan.  31,  giving  sixty-five  treatments  in  all.  I  understand  that  his 
health  has  been  even  better  since  recovery  than  before  the  attack. 


FIG.  51.     Back  view  of  case  50. 


The  treatment  I  gave  daily  was  to  spearate  each  vertebra,  move 
both  sidewise  and  apart  so  as  to  give  free  circulation  to  the  cord  and  take 
out  all  contractions  of  spinal  muscles.  Gentle  treatment  of  abdomen  and 
loosening  of  the  muscles  of  the  limbs  along  the  course  of  the  blood  vessels 
and  nerves. 

I  have  had  altogether  about  twenty  cases  of  infantile  paralysis  and 
very  good  results  in  all ;  but  the  results  were  more  marked  in  this  case, 
due  no  doubt  to  getting  the  case  so  soon  after  the  fever.  If  we  could  »vi 
these  cases  at  the  first  we  could  save  90  per  cent  in  my  opinion. 


CASE  REPORTS 


101 


HARRY  VAN  DORAN,  D.  O.,  Elizabeth,  N.  J. 

Case  18. — Aug.  8,  1916.  Patient,  Lee  Maclnnis,  age  5  years,  male. 
Address,  33  Montgomery  St.,  Newark,  N.  J.  History  of  present  illness: 
Child  arose  in  the  morning  without  apparent  illness;  an  hour  later  com- 
plained of  pain  in  the  abdomen  and  in  the  muscles  of  the  ulnar  portion 
of  t  lie  forearm  and  hand,  left  side.  When  I  arrived  at  1 :30  p.  m.  the  above 
symptoms  were  present  and  there  was  tenderness  over  the  deltoid,  ten- 
derness and  pain  on  slight  pressure  in  first  to  sixth  dorsal  area,  right  uni- 


FIG.  52.     Brace  removed  from  infantile  case — (author's  case). 

lateral  first  and  sixth  dorsal,  both  slightly  posterior,  and  rotated  fourth 
cervical.  Temperature,  103°  F.  I  found  out  that  the  child's  aunt  had 
been  holding  a  child  in  her  arms,  the  child  being  sick  then,  and  a  day  later 
the  case  was  diagnosed  as  acute  anterior  poliomyelitis,  but  without  being 
aware  of  this  she  also  held  Lee  Maclnnis.  There  was  also  a  case  of  anter- 
ior poliomyelitis  in  the  house  next  door,  31  Montgomery  street.  Treat- 
ment :  I  first  manipulated  in  area  affected,  then  adjusted  to  correct  all 
lesions,  gave  an  enema  of  two  quarts  of  tepid  water  and  salt  solution. 
Full  pack,  using  cold  epsom  salt  solution.  Repeated  the  above,  or  por- 


102  POLIOMYELITIS 

tions  of  the  above  treatment,  as  the  case  indicated.  After  the  cold  full 
pack  the  temperature  dropped  to  101  F.  I  remained  with  the  patient 
till  5:30,  when  the  temperature  was  100  4-10  F.  Aug.  9,  9  a.  m.—  Tem- 
perature normal,  muscular  pains  absent. 

Diagnosis — Anterior  poliomyelitis,  abortive  type. 

Addendum:  I  know  of  other  osteopaths  who  have  treated  cases  of 
infantile  paralysis  in  the  acute  stages.  I  have  found  that  all  acute  con- 
tagious diseases  respond  quicker  to  osteopathic  treatment  than  to  the 
medical.  We  osteopathic  physicians  have  not  had  the  opportuinty  to 
take  care  of  an  epidemic  because  all  health  boards  are  composed  of  or 
controlled  by  the  M.  D.'s. 

L.  M.  BUSH,  D.  O.,  Jersey  City,  N.  J. 

Case  19. — A.  C.,  age  9  months;  male.  Previous  history,  pneumonia 
January  ,  1916,  lost  2  pounds  from  16  to  14  pounds;  continued  to  lose 
gradually  until  May,  at  that  tune  weighing  12  pounds.  Onset  present 
illness  about  May  7,  1916;  out  of  sorts  a  few  days  previously  and  slight 
fever.  May  7  it  was  noticed  he  did  not  move  his  limbs.  M.  D.  summoned 
paid  little  serious  attention  to  case  until  a  week  or  two  later  he  pronounced 
it  infantile  paralysis  and  left  a  little  medicine.  May  27  case  brought  to 
my  office  with  both  limbs  entirely  paralyzed  from  the  hips  down.  Could 
not  even  move  his  toes.  Temperature  99  3-5,  pulse  120,  considerable 
rash  on  skin  of  whole  body.  Had  been  fed  on  Eskay's  food,  so  I  changed 
to  modified  milk  formula  and  treated  three  times  a  week.  Lesions  12  D, 
first  and  second  lumbar  posterior,  making  quite  a  lump.  Whole  lumbar 
spine  was  stiff.  I  treated  specifically  these  lesions;  also  used  pressure 
along  the  sciatic  nerve  to  stimulate  and  keep  them  from  degenerating. 
The  baby  could  move  his  toes  in  a  week,  draw  up  his  limb  in  two  weeks 
and  kick  off  the  covers  in  a  month.  Discharged  Aug.  7,  no  paralysis 
gained  3  3-4  pounds  and  perefctly  healthy. 


MARY  D.  MORGAN,  D.  O.,  McMinnville,  Tenn. 

Case  20. — Dr.  Mary  D.  Morgan  tells  of  an  interesting  acute  exper- 
ience which  she  believes  was  anterior  poliomyelitis,  but  diagnosis  is  not 
sure.  Three  years  ago  I  was  called  to  see  a  little  girl  5  years  old,  who  was 
very  ill.  I  had  been  their  family  physician  for  several  years.  I  did  not 
hazard  a  diagnosis  at  the  time  of  the  acute  illness  but  afterwards  conclud- 
ed it  was  infantile  paralysis.  I  gave  all  my  time  to  the  thought  of  what 


CASE  REPORTS 


103 


was  to  be  done  for  her  while  she  was  so  terribly  ill.  The  mother  and  I 
sponged  her  off  and  I  treated  the  neck  gently  and  on  down  the  spine  until 
all  tension  was  removed.  The  fever  fell  several  degrees,  she  quieted 
down,  dozing  off  to  sleep.  The  fever  was  very  high.  Sometimes  she  was 
delirious,  complaining  much  of  back  and  limbs.  This  lasted  for  a  week. 
We  watched  over  her  day  and  night,  doing  all  that  could  be  done.  The 
fever  gradually  subsided;  by  the  fifth  day  she  slept  more  naturally. 

She  complained  of  numbness  in  the  limbs.  I  directed  my  treatment 
more  to  restoring  the  circulation  to  the  limbs.  As  she  gained  strength 
this  numb  feeling  left  and  she  learned  to  walk  as  before.  It  was,  indeed,  a 
hard  fight.  I  am  doing  all  I  can  in  my  humble  way  for  the  people,  and 
to  convert  them  to  Osteopathy. 


FIG.  53.     Brace  removed  after  two  years'  use — (author's  case). 


104 


POLIOMYELITIS 


T.  M.  KING  D.  O.,  Springfield,  Mo. 

Cases  21-22. — About  eleven  years  ago  a  3-year-old  child  was  afflicted 
with  anterior  poliomyelitis  and  had  the  usual  symptoms,  as  I  remember, 
without  having  a  record  of  the  case  to  refer  to,  and  in  addition  a  history 
of  a  fall  previously.  I  was  called  on  the  case  three  weeks  after  paralysis 
had  occurred  and  found  both  lower  limbs  totally  paralyzed.  She  was 
unable  to  move  a  muscle  below  her  waist.  The  only  lesion  found  was  a 
posterior  condition  of  the  fourth  dorsal.  In  six  weeks'  treatment  the 
child  made  a  complete  recovery. 

Another  case  was  stricken  in  the  month  of  August  with  the  usual 
history,  vomiting,  high  fever,  headache;  and  on  the  third  day  the  right 


FIG.  54.  The  nerves  pass  down  the  arm  from  the  spinal  cord.  The  flaccid  and 
atrophied  muscles  in  infantile  paralysis  cases  are  restored  by  treating  the  spinal  cord 
centres.  Osteopathy  affords  speedy  relief  in  these  cases. 

leg  was  paralyzed.  When  I  first  saw  her  the  following  December  she 
had  but  little  use  of  the  limb  and  was  unable  to  support  her  weight  on  it. 
During  three  months'  treatment  she  improved  sufficiently  to  walk  with- 
out support.  I  have  no  doubt  she  improved  much  more,  for  I  referred 
her  to  an  osteopath  in  Kansas,  as  they  were  leaving  Springfield,  but  I 
lost  track  of  the  case. 

I  have  treated  other  cases,  but  have  had  very  little  success  in  any 
case  that  was  of  more  than  one  year's  duration. 

I  realize  these  are  very  unsatisfactory  reports  and  I  cite  them  only 
for  the  encouragement  they  may  lend  to  others  who  come  in  contact 
with  this  dread  disease.  By  all  means  get  the  cases  early  if  possible. 


CASE  REPORTS 


105 


W.  W.  HOWARD,  D.  O.,  Medford,  Ore. 

Case  23. — In  September,  1913,  two  children,  boy  and  girl,  were 
stricken  with  anterior-poliomyelitis  at  the  same  time.  They  were  about 
the  same  age.  The  boy,  2  years  old,  came  down  with  the  disease  on 
Monday.  I  was  called  and  began  to  treat  him  the  following  Sunday. 
First  he  was  taken  to  a  very  fine  M.  D.  and  surgeon,  who  diagnosed  it  as 
infantile  paralysis  and  said  he  would  never  walk.  The  right  leg  was  para- 
lyzed. In  two  weeks  he  began  to  try  to  stand.  I  treated  him  ten  months. 
Result :  Complete  recovery,  both  as  to  size  and  strength  of  leg. 


FIG.  55.     Braces  have  been  taken  off  by  the  score  through  osteopathic  measures. 

The  little  girl  is  still  in  bed,  helpless.  They  have  had  her.  up  and 
down  the  coast  to  different  specialists  with  no  results.  They  never  took 
her  to  an  osteopath.  They  were  told  of  my  success,  but  for  some  reason 
would  not  try  Osteopathy.  (I  was  told  because  of  prejudice  against  any 
system  that  was  non-drug.)  I  was  also  told  that  both  children  had  been 
affected  to  about  the  same  degree.  But  of  this  detail  I  cannot  vouch. 


K.  T.  VYVERBERG,  D.  O.,  Lafayette,  Ind. 

Case  24. — I  want  to  relate  my  experience  with  a  case  of  infantile 
paralysis  I  treated  that  made  a  complete  recovery.  Boy,  five  years  old, 
became  paralyzed  early  part  of  July,  1912.  Called  to  see  him  four  or 
five  weeks  later.  Medical  treatment  up  to  that  time.  Entirely  help- 
less when  I  first  saw  him.  Both  legs  equally  affected,  arms  slightly,  all 
back  muscles,  and  muscles  of  neck;  could  not  raise  his  head  from  bed. 
Suffered  considerable  pain.  Spine  contracted  and  very  sensitive.  Re- 
flexes gone.  Commenced  light,  gentle,  general  treatments  daily  for  about 
seven  days.  Hot  fomentation  to  back  daily;  also  instructed  mother  to 
nil)  legs  and  arms  and  back  lightly  once  or  twice  daily.  We  noticed 


106 


POLIOMYELITIS 


considerable  improvement  at  end  of  first  week.  Treatment  every 
other  day  for  about  two  months.  Then  twice  a  week  for  a  while.  Then 
once  a  week  for  some  time.  Had  boy  under  my  care  for  about  a  year, 
at  the  end  of  which  time  I  pronounced  him  well.  His  entire  muscular 
system  is  now  as  strong  as  any  boy  of  his  age.  His  endurance  is  good. 
The  knee  reflexes  have  not  returned,  but  possibly  may  in  time.  We  must 
get  these  cases  early  to  get  the  best  results.  The  parents  of  the  little 
boy  think  that  osteopathic  treatment  can  perform  miracles,  as  their  first 


FIG.  56.     Plaster  paris  cast  removed  from  boy  aged  3 — (author's  case). 

doctor  told  them  that  their  child  would  probably  be  helpless  the  rest  of 
his  life. 

I  treated  a  number  of  other  cases  that  were  brought  to  me  after  dis- 
ease had  been  standing  a  year  or  longer.  I  found  that  I  could  not  im- 
prove them  very  much,  except  possibly  their  general  health. 


I.  L.  JAMES,  D.  O.,  Springfield,  Mo. 

Case  25. — In  July  1913,  we  had  about  fifteen  cases  of  infantile  par- 
alysis in  Springfield.  On  July  3rd  I  was  called  to  see  a  little  boy  about  three 
years  old,  and  on  arriving  at  the  house  was  given  the  history  of  the  case, 
and  was  told  that  the  child  had  been  under  the  care  of  the  family  physician. 
On  June  30th  the  child  was  taken  suddenly  ill  with  nausea,  vomiting, 
malaise,  and  temperature  running  up  to  103°.  The  medical  man  diag- 
nosed the  case  as  acute  indigestion,  and  when  he  was  called  again,  three 
days  later,  found  the  legs  of  his  patient  both  completely  paralyzed.  His 
diagnosis  was  then  given  as  infantile  paralysis,  and  he  told  the  parents 


CASE  REPORTS 


107 


that  there  was  very  little  that  he  could  do,  merely  leaving  a  tonic,  and 
instructing  them  to  give  him  warm  baths  every  day.  He  further  told 
them  that  the  condition  that  the  boy  would  be  in  a  year  from  that  time 
would  be  his  permanent  condition  for  life. 

After  making  an  examination  I  was  satisfied  that  the  medical  man's 
diagnosis  was  correct,  and  in  response  to  the  questions  of  the  parents 
told  them  I  was  confident  that  Osteopathy  could  effect  a  cure,  as  I  had 
been  able  to  secure  the  case  in  its  early  stages,  and  our  experience  had 
shown  that  in  most  cases  of  this  kind  we  were  able  to  secure  wonderful 
results,  particularly  when  the  case  was  received  in  the  early  stages  of  the 
•disease. 


FIG.  57.    Curvature  weakens  the  body  and  causes  nervous  instability. 

The  case  was  given  me,  and  I  went  to  work.  I  visited  the  child 
once  a  day,  giving  him  osteopathic  treatment  and  instructing  the  mother 
to  give  him  warm  baths  each  day.  As  before  stated,  at  the  begin- 
ning of  the  treatment  both  limbs  were  completely  paralyzed.  At  the 
end  of  three  treatments  the  child  was  able  to  crawl  around  on  the  floor, 
and  after  about  ten  treatments  was  able  to  walk  by  being  supported. 
From  that  time  on  recovery  was  rapid,  but  I  continued  the  treatments 
until  forty-four  had  been  given.  I  see  this  child  frequently,  and  will  say 
that  he  is  as  healthy,  strong  and  active  as  any  normal  child,  and  shows  no 
signs  of  muscular  weakness  or  atrophy  in  his  lower  limbs.  I  had  this  case 
before  our  local  osteopathic  association,  and  the  doctors  were  all  delighted 
with  the  results  obtained. 


BERNARD  S.  MCMAHAN,  D.  O.,  Washington,  D.  C. 

Case  26. — Child,  age  3  years;  six  weeks  previous  to  treatment  she 
lost  use  of  right  limb ;  had  walked  normally  for  age  previously.     Muscles 


108 


POLIOMYELITIS 


just  beginning  to  lose  tone.  After  six  weeks'  treatment  she  regained  use 
of  limb  very  materially.  Stopped  treatment  on  account  of  moving, 
but  the  improvement  continued  and  nearly  a  year  later  I  learned  there 
was  no  trace  of  the  disease. 


RALPH  D.  HEAD,  D.  O.,  Pittsfield,  Mass. 

Case  27. — Girl,  4  years  of  age,  attack  came  on  in  the  usual  manner. 
For  four  weeks  was  under  the  care  of  an  orthopedic  man  without  results. 
The  legs  were  paralyzed  and  during  that  time  there  was  absolutely  no  im- 
provement. The  M.  D.  was  discharged  and  I  was  called  at  the  fifth 
week.  Both  legs  absolutely  paralyzed.  Muscles  of  right  leg  very 
flaccid  and  less  tone  than  left.  Treatment  was  as  follows:  Twice  a  day 


FIG.  58.     The  curvature  found  in  a  spine  is  usually  in  proportion  to  the  difference 
in  the  length  of  the  limbs. 

the  mother  (who  by  the  way,  is  a  trained  nurse,  and  can  therefore  carry 
out  instructions  intelligently)  gave  the  child  a  hot  bath,  with  a  handful 
of  mustard  in  water.  The  child  was  given  a  thorough  massage  of  the 
muscles  three  times  a  day.  The  limbs  are  at  all  times  kept  warm.  To 
accomplish  this  I  keep  woolen  underwear  on  the  child  and  at  first  used  in 
addition  flannel  cloths  to  wrap  around  legs.  Specific  osteopathic  treat- 
ment has  been  given  to  loosen  up  the  lumbar  region,  which  in  this  case1 
was  very  stiff  and  rigid.  There  were  no  obvious  structural  changes. 
Prescribed  resisting  exercises  which  would  bring  into  play  all  muscles  of 
thigh  and  leg.  Let  me  say  that  this  latter  has  got  to  be  done  very  slowly 


CASE  REPORTS  109 

and  patiently  and  must  be  persisted  in.  It  must  not  at  any  one  time  be 
r;ii Tied  to  the  point  of  fatigue,  but  be  done  enough  times  so  that  at  the 
end  of  day  the  child  will  have  had  practically  all  the  exercise  it  can  stand 
and  be  comfortably  tired.  Great  care  must  be  exercised  to  see  that  the 
muscles  which  present  the  most  marked  symptoms  of  paralysis  shall  re- 
ceive their  resisting  exercises  or  else  the  child  will  be  over-developed  in 
one  set  and  an  opposing  group  will  be  so  weak  that  it  results  in  con- 
tiacturcs  and  deformities.  Result,  after  four  weeks  of  treatment,  the 
child  can  now  use  legs  in  most  all  of  their  normal  movements  with  the 
exception  of  extending  legs  on  thighs.  I  might  add  in  treatment,  that  I 
do  not  let  the  child  get  on  to  her  feet  as  yet,  depending  entirely  upon  the 
exercises  to  strengthen  her  limbs. 

These  cases  are  not  for  the  hurried  or  three  minute  osteopaths.  On 
the  contrary,  they  must  be  studied  carefully  and  intelligently.  The  care 
of  the  child  by  nurse  or  parents  is  of  the  greatest  importance,  and  unless 
you  can  have  their  faithful  following  out  of  your  instructions  you  are 
only  half  accomplishing  what  might  be  done. 


Louis  E.  WYCKOFF,  D.  O.,  Los  Angeles,  Calif. 

Cases  28-29. — We  had  an  epidemic  in  July,  1912,  in  which  I  had  exper- 
ience with  two  cases  of  recent  infection,  but  not  during  acute  symptoms 
and  not  until  after  fever  had  subsided.  So  I  cannot  say  anything  about 


FIG.  59.     Level  shoulders  and  hips  are  usually  found  where  no  spinal  curvature 

exists. 

the  results  of  osteopathic  treatment  during  the  acute  stage.  I  was  called 
in  each  case  about  a  week  after  the  fever  abated. 

One,  a  boy  of  16,  had  paralysis  of  the  leg,  arm  and  face,  and  I  suc- 
(•(•(•< led  in  overcoming  all  but  the  paralysis  in  one  leg. 

The  other,  a  baby  of  two  years,  had  been  left  with  facial  paralysis. 
This  was  entirely  corrected. 


110  POLIOMYELITIS 

One  thing  I  feel  quite  positive  of  is  that  it  is  infectious,  but  not 
actively  contagious.  Both  of  these  cases  came  in  contact  with  children 
up  until  quarantined  and  not  one  case  was  traceable  to  them,  nor  was 
there  any  in  their  respective  neighborhoods. 

I  believe  that  Osteopathy  will  show  best  results  in  all  these  cases, 
early  or  late. 

Practitioners  cannot  be  too  careful  in  asepsis  and  hygiene,  because  I 
know  danger  from  infection  is  great.  We  know  a  young  physician  who 
is  a  hopeless  cripple  from  contracting  this  disease  from  a  case. 


C.  L.  NELSON,  D.  O.,  Logansport,  Ind. 

Case  30. — I  wish  to  call  your  attention  to  the  epidemic  of  anterior 
poliomyelitis  that  passed  over  this  country  in  1909  and  1910,  since  which 
time  I've  had  under  treatment  with  varying  success  at  least  twenty-five 
cases,  and  have  seen  even  a  larger  number  of  chronic  cases  leave  my 
office  because  I  would  not  encourage  them  to  expect  speedy  and  com- 
plete recovery. 


FIG.  60.     Curvature  undermines  the  health. 

During  this  wave  of  which  I  speak  I  was  not  privileged  to  see  any  of 
the  cases  in  the  active  or  acute  stage,  and  of  the  fifty  or  more  cases,  of 
which  I  knew,  reported  as  such,  I  think  but  four  resulted  fatally.  My 
cases  have  ranged  in  age  from  2  years  to  30  years  and  from  a  slight 
damage  to  one  hand  to  complete  paralysis  of  hand  and  arm  and  a  com- 
plete paralysis.  Of  twenty-one  cases,  fifteen  were  female.  The  great- 
est obstacle  in  treatment  of  these  chronic  cases  is  to  get  the  parents  to  be 
persistent — to  stay  with  the  treatment  for  two  or  three  years,  or  during 
the  growth  and  development  of  the  child,  but  where  I've  been  able  to 
have  them  realize  the  situation  I've  had  results  that  were  very  satis- 
factory to  them  as  well  as  to  myself.  Another  obstacle  in  our  treatment 
is  the  lack  of  knowledge  of  the  pathology  of  the  disease.  It  is  recog- 
nized as  infectious  and  contagious,  but  of  all  the  cases  in  this  county  I 


CASE  REPORTS 


111 


know  of  but  two  families  where  there  was  more  than  one  case,  and  this 
in  face  of  the  fact  that  many  of  them  were  not  recognized  and  correctly 
diagnosed  in  their  earlier  stages  and  no  quarantine  or  preventable  meas- 
ures were  adopted. 

Am  sorry  to  confess  I've  never  kept  case  reports  in  any  of  these  cases, 
but  as  I  look  over  my  list  I  recall  each  of  them  and  their  damage  and 
history.  Could  write  for  each  of  them  quite  a  complete  outline.  One 
peculiar  thing  I've  noted  is  that  the  damage  is  not  always  in  proportion 
to  the  severity  of  the  acute  attack — in  other  words,  cases  that  were  badly 
damaged  were  reported  as  having  had  but  a  few  hours  or  a  day  or  two  of 
illness,  while  cases  with  slight  damage  were  reported  as  having  had  a  most 
serious  illness. 


ALICE  N.  WILLARD,  D.  O,  Norfolk,  Va. 

Case  31. — Two  young  naval  officers  on  board  ship  worked  all  day 
in  the  bilgewater.  That  night  they  were  off  duty,  on  shore  together. 
Both  were  taken  with  infantile  paralysis  and  treated  by  the  naval  hos- 
pital physicians.  One  of  them  had  no  other  treatment  and  when  last 
heard  from  was  still  in  a  wheel  chair.  The  other  "lived  up  to  the  light, " 
as  it  was  shown  him.  He  had  massage  and  later  when  hearing  the  good 
news  of  Osteopathy  came  to  us  for  treatment.  He  improved  rapidly 
and  when  called  away  on  duty  had  only  a  very  slight  limp. 


FIG.  61.  Infantile  paralysis  deforms  the  little  ones  unless  they  are  properly 
treated.  The  shortened  and  withered  leg,  the  tilted  hips,  and  the  affected  nerves  are 
shown. 


112  POLIOMYELITIS 

It  has  been  my  good  fortune  to  have  had  the  opportunity  of  watching 
closely  the  cases  of  two  boys. 

At  the  opening  of  a  country  school  two  boys  drank  freely  of  the 
water  from  a  well  that  had  not  been  cleaned  out  since  the  year  before. 
Both  were  taken  with  infantile  paralysis  and  treated  by  the  same  M.  D., 
with  the  usual  results.  The  one  having  no  other  treatment  has  made  no 
progress  toward  recovery,  remaining  about  the  same.  The  other  was 
brought  to  me  for  treatment  and  is  now  perfectly  well,  feeling  only  a 
slight  weakness  in  the  right  leg  when  stepping  up.  As  I  treated  this 
case  myself  alone  I  had  a  good  opportunity  to  study  it. 

My  husband,  the  late  Dr.  William  D.  Willard,  had  wonderful  suc- 
cess in  infantile  paralysis,  having  treated  some  children  at  the  same  time 
the  M.  D.'s  were  treating  others  during  an  epidemic.  His  cases  recovered 
without  the  serious  results  that  the  others  experienced.  I  am  sorry  that 
I  cannot  give  you  the  details  in  these  cases  also. 


E.  C.  HIATT,  D.  O.,  Payette,  Idaho 

Case  32. — The  one  case  of  infantile  paralysis  (in  a  boy  of  5),  which 
I  have  treated,  came  with  a  history  of  a  fall  out  of  the  back  of  a  wagon 
on  to  the  head;  and  as  the  facial  muscles  were  the  first  to  show  paralysis 
the  diagnosis  was  uncertain.  The  arms  were  not  affected,  but  the  left 
side  of  the  face  and  both  legs  were  almost  completely  paralyzed.  It 
was  several  days  before  there  was  much  prostration.  After  nearly  two 
months  he  began  to  walk  again.  Gentle  and  thorough  relaxation  of  all 
spinal  musculature  I  regarded  as  an  important  part  of  the  treatment. 
Medical  books  to  which  I  have  access  say  nothing  about  the  facial  mus- 
cles as  likely  to  be  involved  in  this  disease;  but  I  remembered  that  Dr. 
Laughlin  had  mentioned  that  they  were  sometimes  affected,  and  that 
helped  form  my  conclusions,  until  Dr.  Gerdine  confirmed  the  diagnosis 
fully.  For  a  long  time  the  child  walked  with  a  limp  and  the  mouth  was 
drawn  around  to  the  right  side,  but  now,  after  a  year,  there  is  very  little 
evidence  of  his  trouble  to  be  found. 


C.  A.  BLACK,  D.  O.,  Lima,  Ohio 

Case  33. — A  prominent  medical  doctor  in  Lima,  Ohio,  claimed  that 
little  Helen  Watkins  would  always  be  a  cripple,  following  an  attack  of 
infantile  paralysis.  After  such  a  prognosis  the  mother  became  discour- 
aged and  was  advised  by  a  friend  to  try  Osteopathy.  The  patient  has 


CASE  REPORTS  113 

completely  recovered  from  paralysis  of  the  entire  right  side  in  three 
months'  treatment,  with  no  deformity.  The  patient  is  4  years  old  and 
condition  is  believed  to  have  been  caused  from  a  fall  down  cellar  stairs. 
Her  sixth,  seventh  and  eighth  dorsal  were  rotated  to  right  with  very 
marked  lesions  and  rigidity.  Right  innominate  was  posterior,  causing 
considerable  difference  in  the  length  of  legs.  There  have  been  five  cases 
of  infantile  paralysis  in  Lima  thus  far;  one  case  died,  three  were  left  with 
deformity  and  one  case  entirely  cured. 


EUGENE  PITTS,  D.  O.,  Bloomington,  111. 

Case  34. — I  could  not  write  a  scientific  case  report  to  save  my  soul, 
but  I  have  had  many  cases  of  infantile  paralysis  and  as  they  vary  in  vio- 
lence so  greatly  it  would  be  necessary  to  keep  strict  case  reports  on  every 
case  to  give  definite  conclusions.  But  generally  speaking,  I  have  decided 


FIG.  62.     The  lungs  are  more  perfectly  shaped  when  no  spinal  curvature    is 
present. 

lesions  at  the  atlas,  3  C.,  11  and  12  D.,  and  3  and  4,  lumbar,  to  be  the 
cause  of  the  disease,  and  I  have  never  known  of  a  single  death  from  this 
disease  in  this  town  in  nearly  sixteen  years  of  practice  where  a  D.  O. 
was  called  in  in  any  reasonable  time.  I  remember  the  case  of  Sylvia 
Green,  3  years  old,  who  was  stricken  five  years  ago  last  March,  and 
was  delirious  when  I  arrived,  but  after  three  hours'  osteopathic  work, 
with  high  enemas,  and  hot  baths,  was  restored  to  consciousness  and 
made  a  complete  recovery.  Sylvia  is  now  a  little  past  8  and  is  going  to 
country  school  every  day  and  is  a  perfectly  healthy  child. 


T.  OREN  WATSON,  D.  O.,  Seattle,  Wash. 

Case  35.— My  youngest  sister  was  stricken  with  the  sporadic  type  of 
this  malady  eighteen  years  ago  at  the  age  of  eleven  months.     This  gave 


114 


POLIOMYELITIS 


me  an  opportunity  to  watch  the  case  and  its  handling  by  the  best  medical 
doctors  in  our  locality,  which  was  in  an  Eastern  State. 

The  child  had  the  usual  apparent  light  cold,  but  on  the  morning  of 
the  third  day  of  her  supposed  cold  the  right  leg  hung  limp.  She  was  im- 
mediately taken  to  the  best  medical  men  available,  but  they  were  all  at  a 
loss  to  know  what  was  wrong.  They  advised  the  use  of  a  battery,  which 
caused  the  baby  to  scream  with  pain  throughout  the  treatment,  but  out- 
side of  that  she  was  cheerful  and  happy.  During  the  electrical  treat- 
ment the  little  thing  would  reach  down  and  try  to  pull  the  helpless  limb 
away  from  its  tormentors.  This  treatment  was  continued  for  a  while, 
with  no  help.  The  case  was  then  taken  from  one  medical  doctor  to 


FIG.  63.     The  bony  framework  protects  the  central  nervous  system. 

another  for  seven  months  with  many  diagnoses,  none  of  which  were  cor- 
rect. The  prognosis  was  always  hopeless.  About  this  time  an  osteo- 
pathic  physician  was  engaged  who  succeeded  in  giving  her  some  use  of 
the  limb,  but  just  what  groups  of  muscles  were  again  brought  into  action 
I  cannot  say,  as  my  knowledge  of  anatomy  in  those  days  was  somewhat 
limited.  I  have  forgotten  just  what  actions  she  regained,  but  mother 
advises  that  she  took  two  steps  after  a  month's  osteopathic  care.  Then 
she  fell  ill  with  cholera  infantum  and  died  in  seven  days,  as  mother 
thought  she  was  too  sick  to  take  to  the  osteopaths,  who  were  twenty 
miles  away.  She  called  in  the  medical  men  again  for  this  latter  com- 
plaint, under  whose  care  she  passed  away.  I  have  since  cured  many 


CASE  REPORTS  115 

cases  of  acute  diarrhea  in  both  old  and  young  with -no  failures,  and  if  I 
had  known  as  much  then  as  now,  or  if  mother  had  taken  sister  back  to  the 
osteopaths  for  the  complaint  that  proved  fatal,  we  might  have  had  her 
with  us  yet.  In  later  years,  while  I  was  in  training  for  my  profession, 
this  disease  (infantile  paralysis)  came  under  my  consideration.  Im- 
mediately I  diagnosed  my  sister's  case,  and  this,  I  am  sure,  was  the  first 
correct  diagnosis. 

The  disease  under  consideration  was  first  discovered  in  1840  in 
Europe,  where  it  is  quite  prevalent  yet  and  they  still  have  frequent 
epidemics. 

There  have  been  a  few  epidemics  in  the  United  States,  also  in  Aus- 
tralia. There  was  an  epidemic  in  Los  Angeles  a  few  years  ago.  This  is 
the  location  of  my  Alma  Mater  and  they  naturally  handled  a  number  of 
cases  the  in  the  college  clinic,  with  uniformly  good  results  when  taken  in 
time. 

As  you  know,  the  specific  organism  causing  the  disease  has  not  been 
discovered  and  probably  will  not  be  until  our  microscopes  are  made  much 
stronger  than  now,  as  it  passes  through  the  finest  porcelain  filters 
very  readily. 

The  organism  seems  to  thrive  in  the  secretions  of  the  nose,  from 
which  secretions  of  a  monkey  suffering  with  the  disease  it  is  possible  to 
transmit  it  by  inoculation  to  other  monkeys  for  several  months. 

The  undiscovered  cause,  be  it  a  germ  or  what  not,  seems  to  attack 
first  the  endothelial  cells  lining  the  terminal  arteries  of  the  central  nervous 
system  and  most  frequently  the  anterior  spinal  branches  of  the  lumbar 
enlargement  in  the  spinal  cord,  in  which  are  located  the  nerve  cell  bodies 
of  the  nerves  that  supply  the  muscles  of  the  lower  extremities.  This 
causes  an  immediate  inflammation  and  round  cell  infiltration  around 
the  artery  in  which  is  located  the  nidus  of  infection.  The  severe  acute 
inflammation  with  the  attendant  swelling  and  other  phenomena  cuts 
off  the  circulation  to  and  crowds  the  anterior  horn  cells  to  such  an  extent 
that  they  undergo  cloudy  swelling,  and  if  not  relieved,  degeneration. 

This  seems  to  be  the  primary  lesion  and  there  are  such  lesions  for 
each  group  of  paralyzed  muscles.  They  probably  all  start  about  the 
same  time.  In  the  cases  that  prove  fatal  one  of  these  primary  lesions 
involves  the  medulla  oblongata  or  later  spreads  to  it  from  the  cervical 
enlargement,  invading  the  upper  .vegetative  centers  or  the  nucleus  of 
origin  of  the  pneumogastric  nerve.  There  are  many  secondary  foci  for 
the  infection  in  various  terminal  arteries  of  the  nervous  system,  but 
before  these  become  as  formidable  as  the  primary  lesion  the  patient,  in 
favorable  cases,  has  developed  a  reaction  and  the  increased  leucocytes 
keep  down  these  secondary  lesions. 


116 


POLIOMYELITIS 


The  lymphoid  tissue,  which  forms  the  white  blood  cells  or  leucocytes,, 
whose  business  it  is  to  fight  all  infections,  increases  very  materially 
throughout  the  body,  thus  showing  that  the  organism  which  causes  the 
disease  is  circulating  in  the  body  fluids  and  exciting  the  protective 
reaction  known  as  leucocytosis. 

After  the  patient  overcomes  the  infection  the  spinal  cord  shrinks 
and  the  anterior  roots  decrease  in  size  at  the  point  or  points  of  the  primary 
lesions  due  to  the  death  of  the  nerve  cell  bodies  in  the  former  and  their 
fibers  in  the  latter. 


FIG.  64.     From  a  girl  of  7  years. 

Symptoms.  The  incubation  period  lasts  about  five  days,  during 
which  the  patient  has  headaches,  pains  and  stiffness  of  the  limbs  with  a 
fever  running  from  100  to  102.  Following  this  the  paralysis  appears, 
usually  of  one  leg,  but  may  be  one  arm,  both  arms  or  one  leg  and  one  arm 
or  any  other  combination  of  these.  The  paralyzed  member  is  not  anes- 
thetic because  the  sensory  nerve  cell  bodies,  as  you  know,  are  not  located 
in  the  spinal  cord,  but  in  the  posterior  root  ganglia  of  the  spinal  cord.  The 
limb  is  not  painful  unless  injured  or  stimulated  by  heat,  electricity  or 
otherwise.  In  a  few  weeks  the  paralyzed  muscles  begin  to  show  a  disuse 
atrophy. 


CASE  REPORTS  117 

Prognosis.  If  the  case  is  properly  managed  from  the  beginning  so 
as  to  limit  the  damage  done  until  the  body  cells  have  a  chance  to  overcome 
the  invading  organism,  T  consider  the  prognosis  good  for  an  ultimate  re- 
covery with  little  or  no  muscular  loss.  However,  if  the  primary  lesion 
involves  the  medulla  oblongata  the  prognosis,  I  think,  would  be  wholly 
bad,  no  matter  what  treatment  given. 

General  Management.  Two  nurses  should  be  put  on  the  case  at  the 
beginning,  with  nothing  W  do  but  look  after  the  patient  night  and  day. 


FIG.  65.     "Hipping  out"  accompanies  scoliosis;  a  poor  physical  start  in  life  for 
a    child. 

The  patient  should  be  kept  lying  face  down  on  a  feather  pillow  with 
the  body  and  hence  the  spinal  canal  sloping  upward  toward  the  head,  so 
as  to  give  the  return  blood  flow  the  best  opportunity  to  get  away  from  the 
congested  area,  thus  lessening  the  congestion  and  destruction  of  nerve 
cells  in  the  primary  lesions.  The  gentle  upward  slope  of  the  body  and 
spinal  cord  tends  to  keep  the  primary  lesions  from  spreading  toward 
the  brain  stem. 

The  child  under  no  circumstances  should  be  picked  up  and  fondled 
by  loving  mothers  or  other  persons,  as  this  bends  and  twists  the  back  and 
greatly  aggravates  the  already  severe  inflammation,  causing  it  to  spread 
and  involve  more  of  the  nervous  tissue.  The  patient  suffers  no  pain 


118  POLIOMYELITIS 

as  a  result  of  the  handling  and  the  mother,  not  knowing  the  condition 
existing  in  the  spinal  canal,  thinks  that  it  does  no  harm  to  handle  the 
child. 

Treatment.  The  only  treatment  needed  in  the  acute  stage  is  gentle 
intermittent  pressure  lasting  for  five  minutes  on  the  erector  spinse  muscle 
mass  over  the  involved  portion  of  the  spinal  cord,  as  indicated  by  the 
paralyzed  muscles.  This  will  drive  the  blood  out  of  the  tissues  sur- 
rounding the  primary  lesion  toward  the  heart;  this  in  turn  will  drain  the 
excess  of  blood  from  the  cord  through  the  small  veins  passing  through 
the  intervertebral  foramina,  relieving  the  congestion  and  inflammation 
in  the  spinal  canal.  These  treatments  should  be  given  every  hour, 


I 

FIG.  66.     The  nerve  mechanism  of  the  leg. 

night  and  day,  when  the  patient  is  awake.  This  can  be  given  by  the 
nurses  under  the  direction  of  an  osteopathic  physician.  This  form  of 
treatment  should  be  kept  up  for  at  least  four  weeks  and  six  weeks  would 
be  better.  After  that  treatment  should  be  given  to  stimulate  the  circu- 
lation of  the  blood  and  nerve -force  through  the  spinal  cord  and  the 
paralyzed  muscles.  This  will  hasten  the  growth  of  the  nerve  cell  pro- 
cesses of  the  injured,  but  not  destroyed  nerve  cells,  and  help  them  to  re- 
establish their  connections  with  the  paralyzed  muscles.  The  passive 
exercise  of  the  limbs  will  prevent  some  of  the  wasting  until  such  time  as 
the  nerve  cell  damage  can  be  repaired. 

Quarantine.     Each  case  should  be  strictly  quarantined  and  no  one 
except  the  nurses  and  the  physician  should  see  the  patient.     All  dis- 


CASE  REPORTS  119 

charges  from  the  mouth  and  nose  should  be  burned  right  in  the  room  if 
possible  and  all  other  excreta  should  be  thoroughly  disinfected  before 
leaving  the  room.  All  linen  and  clothing  should  be  soaked  in  strong 
soapsuds  of  the  two  per  cent  mercurid  iodide  germicidal  soap  for  several 
hours  before  leaving  the  room. 

The  physician  should  make  an  entire  change  of  clothing  and  put  on 
garments  covering  every  portion  of  his  person  completely,  using  a  respi- 
rator wet  with  soap  suds  of  the  above-mentioned  soap,  and  before  leav- 
ing the  room  this  clothing  should,  while  yet  on  the  physician,  be  thor- 
oughly sprayed  by  the  nurse  with  the  strong  soapsuds,  when  he  should 
retire  to  another  room  and  remove  the  wet  garments,  dropping  them 
into  strong  soapsuds  again.  These  to  be  boiled  without  removing  from 
the  soapsuds  then  hung  out  to  dry  and  be  ready  for  the  next  visit. 

The  nurses  should  care  for  themselves  in  the  same  way. 


U.  G.  LITTELL,  D.  0.,  Santa  Ana,  Calif. 

Case  36. — A.  C.,  girl,  age  4  years.  Under  M.  D.  care  first  week. 
Diagnosed  sciatica.  I  was  called  Nov.  15,  1911,  the  8th  day  of  the 
disease.  I  found  the  left  leg  in  a  state  of  flaccid  paralysis  and  the  little 
patient  suffering  from  nocturnal  paroxysms  of  pain,  accompanied  by 
intense  itching  all  over  the  paralyzed  limb.  The  pain  recurring  about 
every  hour.  I  gave  treatment  every  hour  the  first  night,  and  with 
increasing  intervals,  for  eight  nights.  Then  three  times  per  week  to 
Nov.  29,  then  twice  a  week  to  Jan.  22,  1912. 

Result:  patient  walked  with  crutches  about  a  month,  then  laid 
them  aside  with  fair  use  of  the  limb.  At  present,  after  six  and  one-half 
years,  the  affected  limb  is  slightly  shorter  and  considerably  smaller  than 
the  other,  showing  that  certain  trophic  nerve  centers  in  the  cord  were 
disabled. 

Treatment  in  this  case  was  directed  to  the  relaxation  of  tense  spinal 
tissues  and  encouraging  elimination,  with  passive  movements,  at  first, 
and  later  active  resistive  movements  of  the  affected  part. 

Case  37. — A.  M.,  male,  age  18  years.  As  in  Case  No.  36  this 
patient  came  under  my  care  a  week  after  initial  fever  appeared.  I  found 
an  oversized  young  man  weighing  200  pounds,  with  partial  paralysis  of 
the  right  arm  and  the  left  leg. 

Initial  symptoms  were  described  as  a  "grippy  cold. "  Here  I  found 
tension  and  tenderness  from  occiput  to  sacrum.  Treatment  was  given 
twice  daily  for  six  days,  then  once  a  day  for  twelve  days,  when  with  slight 


120  POLIOMYELITIS 

improvement,  he  was  taken  to  another  city.  Later  he  was  placed  under 
the  care  of  another  osteopath  and  made  a  complete  recovery  in  about  a 
year  from  date  of  initial  attack. 

Case  38. — M.  H.,  male,  6  years  old.  Had  classical  symptoms  of 
anterior  poliomyelitis  with  complete  right-sided  paralysis  when  one  year 
old.  When  brought  to  me  he  had  fully  recovered  the  use  of  the  leg  but 
the  wrist  was  flexed  at  a  right  angle  and  the  fingers  flexed  to  the  palm. 
He  had  never  used  the  right  hand.  The  mother  stated  that  when  he 
was  asleep  the  wrist  and  fingers  would  straighten  out.  In  this  case  the 
first  dorsal  vertebra  was  lateral  to  the  right.  This  was  easily  corrected. 
Treatment  twice  a  week  for  seven  weeks  with  gradual  improvement. 
I  used  a  splint  to  keep  the  wrist  in  extension  between  treatments. 


J.  P.  FOGARTY,  D.  O.,  Michigan  City,  Ind. 

Case  39. — Dorothy  Thornton,  Michigan  City,  Ind.,  age  5.  Family 
history  good.  Previous  history  of  child,  unusually  good  health.  Present 
illness:  Following  a  three  weeks'  stay  in  the  hospital  for  what  was  diag- 
nosed as  acute  poliomyelitis,  the  child  was  brought  to  me  with  a  flaccid 
paralysis  in  the  anterior  tibial  and  peroneal  group  of  muscles  in  one  leg. 

When  first  seen  by  the  family  physician,  was  said  to  have  fever,  pain 
in  the  neck  and  spine  with  head  drawn  back  (opisthotonos),  followed 
by  paralysis. 


t 


FIG.  67.  The  normal  arch  of  a  foot  is  wonderful  in  construction  and  arrangement. 
The  black  line  is  the  large  nerve  that  supplies  the  muscles  in  the  sole  of  the  foot. 
Infantile  paralysis  weakens  the  arch. 


CASE  REPORTS  121 

The  child  was  treated  daily  for  about  one  month  with  a  general 
spinal  treatment  and  manipulation  of  the  leg.  Later,  twice  or  three 
times  per  week  for  7  or  8  months.  During  the  first  month  treatments 
were  given  very  light  but  general,  later  on  more  specific  and  heavier. 

There  was  a  gradual  improvement  from  the  first  and  by  the  seventh 
or  eighth  month  had  completely  recovered  and  had  a  normal  gait. 

This  particular  case  would  seem  to  show  that  a  complete  cure  is 
possible  when  osteopathic  treatment  is  started  early  and  kept  up.  I 
consider  this  rather  a  light  attack,  although  the  child  was  said  to  have 
been  quite  ill  at  first. 

A.  G.  WALMSLEY,  D.  O.,  Peterborough,  Ont.,  Can. 

Case  40. — Girl,  aged  five.  This  case  first  came  under  my  notice 
October  26,  1917.  The  history  is  as  follows:  Some  five  weeks  previously 
the  mother  of  the  child  found  one  morning  that  the  child  was  unable  to 
raise  up  or  to  turn  over  in  bed,  and  would  not  allow  any  one  to  touch 
her  about  the  trunk  or  lower  limbs  because  of  the  pain  resulting  therefrom. 
An  M.  D.  was  called,  who  after  examining  the  case  pronounced  it  hip 
disease.  The  prognosis  was  grave;  he  said  that  the  child  might  not  even 
live,  and  that  if  she  did  she  would  be  a  cripple.  In  the  week  immediately 
following,  the  child  improved  slightly,  its  mother  being  able  to  handle  it 
somewhat,  but  it  was  still  confined  to  bed.  At  the  expiration  of  two 


FIG.  68.  "Broken  arch."  The  arrow  indicates  one  joint  that  is  opened  up. 
Notice  the  heel-bone  sprung  backwards.  Compare  with  Fig.  67  and  note  how  much 
nearer  the  floor  the  arch  is  at  point  of  arrow.  The  nerve  was  left  out  to  show  the 
better  the  sprung  joint. 


122  POLIOMYELITIS 

weeks  the  doctor  in  attendance  asked  for  consultation,  and  the  consulting 
physician  concurred  in  the  diagnosis  and  the  prognosis  of  his  colleague. 
Three  weeks  later,  or  five  weeks  from  the  onset  of  the  trouble,  the  child 
was  brought  to  my  office;  the  mother  carried  the  child  upstairs  and  sat 
her  down  on  the  office  floor,  the  child  not  yet  being  able  to  stand,  and  of 
course  it  could  not  walk.  Before  examining  the  child  I  inquired  carefully 
into  the  history  of  the  case.  As  soon  as  the  mother  mentioned  hip  dis- 
ease I  naturally  was  on  the  alert,  realizing  that  hip  disease  is  not  a  dis- 
ease to  be  trifled  with.  The  history  brought  out  two  very  interesting 
points,  namely:  First,  two  days  before  the  onset  of  the  disease  the 
child  while  playing  in  the  yard  climbed  a  ladder  to  a  height  of  some 
four  or  five  feet  and  from  this  position  fell  to  the  ground.  Second,  this 
child  is  inordinately  fond  of  meat,  and  at  some  meals  will  eat  nothing 


FIG.  69.     "The  spinal  column  is  literally  alive  with  nerves." 

else  if  it  can  get  all  the  meat  it  wants.  It  so  happened  that  at  this  time 
the  mother  of  the  child  was  spending  considerable  time  with  the  neigh- 
bor next  door  whose  husband  was  on  his  death  bed,  and  the  child  was 
with  her  the  greater  part  of  the  time.  While  there  the  neighbor's  daugh- 
ter indulged  the  child's  appetite  for  meat.  That  the  toxic  state  produced 
by  overeating,  and  especially  of  meat,  lowered  the  child's  resistance  and 
made  it  more  susceptible  to  the  paralytic  condition  that  ensued,  seems 
a  reasonable  hypothesis. 

Examination.  My  first  thought  on  examining  the  child  was  to 
confirm  or  disprove  the  diagnosis  of  hip  disease.  This  was  not  a  difficult 
matter,  and  in  a  few  minutes  I  was  able  to  assure  the  mother  that  the 
child  had  not  hip  disease.  She  then  asked  me:  "Well  Doctor,  what's 
the  matter?"  I  answered:  "  Your  child  has  infantile  paralysis. "  Her 


CASE  REPORTS  123 

next  query  was:  "Can  anything  be  done  for  her?"  And  I  assured  her 
the  child  could  be  greatly  helped  and  in  all  probability  cured.  Contin- 
uing with  the  examination,  I  found  slightly  rotated  third  and  fourth 
lumbar  vertebrae  and  a  very  tense  condition  of  the  lumbar  group  of  mus- 
cles and  some  involvement  of  the  muscles  higher  up  in  the  spine. 

The  child  was  still  quite  tender  and  made  quite  a  fuss  during  treat- 
ment, but  after  each  treatment  this  tenderness  was  less  noticeable  and  in 
a  few  days  had  entirely  disappeared.  After  five  treatments  the  child 
was  able  to  walk  by  taking  hold  of  chairs  or  tables,  and  from  this  time  on 
the  improvement  was  rapid.  I  treated  the  child  three  times  a  week  for 
five  weeks,  and  twice  a  week  for  three  weeks  following.  By  this  time 
she  was  walking  very  well  but  would  tire  easily.  I  urged  the  mother  to 
continue  bringing  the  child  once  or  twice  a  week  for  a  time  until  it  would 
be  fully  recovered,  but  for  some  reason  unknown  to  me  she  discontinued. 
The  first  week  in  May,  or  about  four  months  since  I  last  saw  the  child, 
the  mother  brought  her  to  my  office  to  show  me  how  well  she  was.  In- 
quiry revealed  the  fact  that  while  the  child  is  walking  well  and  in  good  gen- 
eral health,  she  still  tires  more  readily  than  before  the  attack  I  again 
urged  the  mother  to  bring  her  back,  but  she  has  not  yet  done  so. 

After  I  had  been  treating  this  case  some  six  weeks,  and  the  child 
had  made  the  splendid  progress  referred  to,  the  child  missed  one  week 
(luring  which  she  was  not  brought  for  treatment.  When  the  mother 
brought  her  back  I  wanted  to  know  why  the  child  had  missed  coming 
the  previous  week,  and  the  mother  informed  me  that  she  had  been  next 
door  nursing  the  neighbor  mentioned  above  and  could  not  bring  the  child. 
The  mother  then  went  on  to  tell  me  that  the  child  had  had  another  very 
sick  turn  and  that  she  thought  it  was  going  to  have  another  attack  similar 
to  the  one  that  prostrated  her  before.  Inquiry  brought  out  the  fact  that 
the  neighbor's  daughter  had  again  been  indulging  the  child  with  all  the 
meat  she  would  eat,  and  added  to  this  some  candy. 

This  was  a  sporadic  case  of  poliomyelitis,  there  being  no  others  in  the 
city  to  my  knowledge  at  that  tune,  and  I  feel  no  hesitation  in  saying  that 
the  causative  factors  in  this  case  were  the  toxic  state  due  to  wrong  food 
and  over-eating,  and  the  effects  of  the  spinal  injury  resulting  from  the  fall. 

Some  four  weeks  after  I  began  treating  the  child,  the  M.  D.  who  was 
called  in  consultation  by  the  physician  in  charge,  saw  the  little  girl  play- 
ing about  in  a  neighbor's  house  and  the  neighbor  and  the  mother  of  the 
child  had  much  difficulty  in  convincing  him  that  this  was  the  child  he 
and  his  colleague  said  might  not  live,  and  that  if  she  did  live  would  be  a 
cripple. 


124  POLIOMYELITIS 

M.  E.  CHURCH,  D.  O.,  Calgary,  Alberta,  Can. 

Cases  41-42. — On  July  10,  1916,  I  got  a  hurry  call  to  come  and 
see  a  couple  of  boys  that  were  unable  to  get  up.  They  had  been 
sick  in  bed  for  only  a  day  and  two  nights,  but  had  not  been  feeling  extra 
well  however  before  this,  which  was  just  after  their  arrival  in  Calgary. 
School  closed  the  last  of  June,  and  the  mother  and  three  boys,  3^,  8  and 
9  years  respectively,  together  with  their  mother,  left  University  Place, 
Edmonton,  to  visit  some  relations  in  the  country,  and  then  to  come  to 
Calgary  to  spend  a  while  with  Mrs.  Johnson's  mother,  the  boys'  grand- 
mother. While  in  the  country  the  boys  played  hard,  as  only  boys  can,, 
had  lots  of  good  things  to  eat,  lots  of  milk  to  drink;  in  fact,  their  father 
runs  the  dairy  of  the  Alberta  University  at  Edmonton.  On  the  train 


FIG.  70.  The  white  tract  within  the  sectioned  spinal  column  is  the  spinal  cord 
with  its  three  surrounding  membranes.  Notice  the  cord  extends  only  down  as  far  as 
the  small  of  the  back.  Between  the  spinal  bones  or  vertebrae  the  spinal  nerves  pass 
out  to  supply  the  muscles  and  organs  of  the  body. 


CASE  REPORTS  125 

coming  down  they  had  some  ice  cream  cones  and  drank  of  the  water  on  the 
train  quite  freely.  As  the  case  history  showed,  they  had  been  in  Calgary 
but  four  days,  neither  of  the  patients,  the  two  older  boys,  felt  extra  well 
after  their  arrival,  but  had  not  complained  to  their  mother  until  the 
night  preceding  the  night  I  was  called,  and  then  it  was  simply  that  their 
legs  were  weak.  The  mother  thought  it  might  have  been  from  playing 
too  hard  that  they  were  sore  and  stiff,  and  had  them  stay  in  bed  the  day 
before.  In  fact,  they  tried  to  get  up  and  couldn't. 

On  arrival  at  the  home  I  found  the  two  boys  in  one  bed  suffering  from 
an  inability,  as  they  expressed  it,  of  drawing  their  legs  up  and  straighten- 
ing them  down.  This  was  particularly  true  of  the  right  leg  of  the  older 
boy,  and  the  younger  boy  (aged  8)  was  similar  except  not  so  bad;  the 
younger  boy's  face  showed  signs  of  slight  paralysis  on  the  right  side, 
which  had  not  completely  recovered  at  the  end  of  two  months. 

The  boys  were  extremely  nervous  and  irritable  and  complained  of 
the  back  hurting.  Having  made  the  usual  tests  carefully,  reflexes,  etc.,  I 
turned  them  one  at  a  time  on  their  faces  and  gently  manipulated  the 
spine.  The  whole  plan  of  treatment  was  for  improved  circulation  to  and 
from  the  cord;  I  then  treated  the  neck  gently,  also  carefully  manipu- 
lated the  musculature  of  the  legs. 

The  boys  were  refreshed  from  the  first,  and  to  make  a  long  story 
short,  I  called  twice  a  day  at  first;  at  the  end  of  two  weeks  the  boys  were 
sitting  up,  able  to  draw  the  legs  around,  and  were  putting  their  weight 
on  in  three  weeks  and  were  taken  to  their  home  in  a  little  over  a  month. 

The  picture  shows  them  standing  on  the  veranda  at  two  months,  and 
shortly  after  this  they  entered  school.  I  often  hear  from  them,  they  are 
both  well  and  as  strong  as  if  nothing  had  ever  happened  to  them.  I 
might  say  the  younger  boy,  who  seemed  to  have  a  predominance  of  the 
Bulbo-Spinal  type,  improved  on  his  feet  the  quicker  for  the  involvement 
was  less  in  the  area  of  the  cord  where  the  nerves  to  the  limbs  were  af- 
fected. The  facial  paralysis  cleared  up  slowly. 

I  will  now  mention  the  fight  we  had  with  the  Health  Officer,  who 
would  not  call  and  see  the  cases  at  first,  and  said  the  injection  of  spinal 
fluid  into  a  monkey  was  necessary  before  a  positive  diagnosis  could  be 
made.  To  nip  this  in  the  bud,  I  wired  New  York,  and  got  a  reply  saying 
that  inoculation  was  not  necessary  in  well-marked  cases.  My  diagnosis 
was  also  sustained  by  the  Health  Officer  of  Edmonton,  and  admitted  to  by 
the  Health  Officer  here  later,  after  he  lost  his  "swelled  head"  and  was 
called  down  by  a  couple  of  the  newspapers. 

I  honestly  believe  from  these  two  acute  cases  and  a  number  of  chronic 
cases  I  have  treated,  that  there  is  no  treatment  that  can  begin  to  com- 
pare with  Osteopathy  in  the  treatment  of  acute  or  chronic  poliomyelitis. 


126 


POLIOMYELITIS 


The  boy  of  three  and  one-half  years  did  not  show  a  symptom  of 
poliomyelitis,  and  he  was  with  the  other  boys  constantly  until  their  con- 
dition was  diagnosed. 

W.  J.  CONNER,  D.  O.,  Kansas  City,  Mo. 

Case  43. — Boy  about  five  years  old.  Examined  1908.  He  was 
brought  to  my  office  paralyzed  from  the  neck  down.  He  could  not  work 
a  muscle  in  arms  or  legs.  Bladder  and  bowels  also  paralyzed.  This 
condition  had  existed  for  about  ten  days. 

Upon  careful  examination  it  seemed  a  hopeless  case.  I  decided 
to  call  counsel;  Drs.  Cornelia  Walker  and  Irene  Harwood  also  pro- 
nounced it  a  difficult  case. 

We  decided  that  osteopathic  measures  offered  the  only  hope  of 
restoring  the  patient,  and  with  that  feeling  I  undertook  to  handle  the 
case. 

Tenderness  of  the  cervical  tissues,  without  any  specific  lesion  was 
noted.  A  relaxing  treatment  was  given,  with  the  object  of  accelerating 
the  circulation  to  the  cord  in  the  cervical  region. 

He  was  given  all  the  oranges  he  wanted  to  eat.  In  one  month's 
time  he  was  sent  home  with  the  use  of  all  his  muscles.  At  home  he  made 


FIG.  71.     Watch  the  kidneys  in  paralysis  cases.     A  curvature  will  weaken  them. 


CASE  REPORTS 


127 


a  perfect  recovery.  I  followed  the  case  for  several  years  and  he  is  now 
as  perfect  as  though  he  had  never  been  affected. 

Case  44. — Baby  two  years  old  developed  the  usual  symptoms  of 
infantile  paralysis.  On  the  third  day  both  legs  were  paralyzed.  It 
proved  to  be  a  mild  case,  as  six  treatments  directed  towards  clearing 
the  circulation  to  the  lower  dorsal  and  upper  lumbar  region  restored  the 
case  to  normal. 

During  my  practice  I  have  received  for  treatment  twelve  cases,  and 
every  one  made  perfect  recoveries  under  the  same  treatment  as  indicated 
above. 

In  order  to  get  the  best  results,  you  must  get  the  case  within  a  week 
or  two  after  the  initial  symptoms.  The  sooner  the  better.  I  have  never 
been  more  than  a  month  curing  any  case. 

Many  are  the  cases  I  have  treated  during  the  chronic  stage  of 
the  disease,  but  never  have  had  the  same  results  as  when  treated  in  the 
acute  stage. 


Fio.  72.     Back  view  of  Fig.  71. 


1 2S  POLIOMYELITIS 

H.  W.  GAMBLE,  D.  O.,  Missouri  Valley,  la. 

Case  45. — Last  August  there  occurred  four  cases  of  infantile  paraly- 
sis in  this  town  within  three  days'  time,  within  a  radius  of  a  half  mile 
distance.  The  youngest  was  six  months  old,  the  oldest  was  five  years. 
Across  the  street  from  the  latter,  the  same  week,  a  lad  seventeen  years  of 
age  was  stricken  with  an  unusual  train  of  symptoms  which  the  two  con- 
sulting M.  D.'s  finally  pronounced  brain  fever  but  had  many  character- 
istic symptoms  of  I.  P.  and  might  as  well  have  been^so  diagnosed 

A  week  later  a  girl  age  22  years  living  sixteen  miles  from  here 
was  attacked  with  infantile  paralysis;  no  other  cases  in  this  com- 
munity developed  that  I  know  of,  and  all  of  the  above  came  into  our 
care  soon  after  they  were  diagnosed  (but  diagnosis  was  never  made  until 
after  paralysis  was  established).  There  seemed  no  possibility  of  a  com- 
mon infection  or  exposure  to  such.  But  one  case  was  quarantined  by  the 
attending  physicians  and  it  was  more  isolated  than  the  rest.  Two  cases 
permitted  a  number  of  other  children  to  become  exposed  but  no  other 
cases  resulted. 

One  case  was  taken  much  the  same,  almost  identically,  the  family 
claimed,  as  a  little  brother  two  weeks  later  whom  I  treated  from  the  out- 
set and  in  three  days  he  was  well,  with  no  paralysis  developing;  the 
family  feels  Osteopathy  prevented  serious  results  as  followed  the  case 
under  medical  treatment  before  they  called  the  osteopath. 

Climatic  conditions  in  the  above  little  epidemic  seemed  to  have 
much  to  do  with  its  presence.  It  was  dry  and  dusty.  During  the  past 
eighteen  years  we  have  had  probably  more  than  an  average  acute  prac- 
tice in  our  field,  and  have  had  many  cases  to  treat,  most  of  them  coming 
to  us  some  months  or  years  after  paralysis  is  established.  Our  treat- 
ment for  the  chronic  conditions  has  been  probably  the  average,  and 
results  ditto.  It  has  been  our  practice  to  treat  the  chronic  cases 
more  strongly  and  less  frequently  then  the  acute,  otherwise  it  has  varied 
less  than  it  appears  to  with  some  D.  O's.  These  cases  all  presented  much 
the  same  history  and  symptoms,  only  in  varying  degrees  of  intensity, 
digestive  disturbances  predominating  and  most  of  them  were  treated 
accordingly  by  the  M.  D.'s;  i.  e.  for  above  symptoms,  as  infantile  paralysis 
was  not  suspected  in  any  until  paralysis  intervened.  F.  E.,  age  3  years 
was  most  seriously  afflicted,  though  in  apparently  good  health  previously. 
Family  history  rather  bad,  father's  habits  bad,  mother's  health  poor. 
Two  medical  doctors  handled  the  case  for  about  three  weeks  when  they 
advised  the  family  to  try  Osteopathy.  The  right  arm,  back  and  legs 
were  paralyzed,  though  had  a  trifle  use  of  the  hand.  No  motion  in 
either  leg  or  foot  and  back  muscles  paralyzed  also.  Very  fretful  and 


CASE  REPORTS 


129 


nervous,  had  to  be  turned  every  few  minutes  night  and  day  for  the  first 
month  of  illness.  Stomach,  bowels  and  kidneys,  all  in  bad  condition,  air 
hunger  and  dyspnoea  pronounced  the  first  week  of  treatment.  Medi- 
cation had  been  modest  but  took  scarcely  any  after  starting  treatment, 
and  discontinued  in  a  week.  Hyperesthesia  most  pronounced  thruout 
the  spinal  area,  with  no  portion  more  affected  than  the  other.  Con- 
traction of  soft  tissues  less  than  would  be  found  in  most  any  other  acute 
illness  of  same  severity.  Treated  daily  for  two  weeks,  thrice  weekly  for 
two  weeks,  then  twice  weekly  from  October  1,  1917  to  date  April  1,  1918. 
Treatment  was  very  gentle;  slow,  relaxing  and  inhibitory  throughout 
the  spinal  area.  General  conditions  unproved  from  the  first  treatment. 
The  child  was  turned  on  either  side  and  as  hyperesthesia  was  relieved 
the  treatment  was  increased  to  comfortable  toleration.  Both  legs  were 


FIG.  73.  A  section  of  the  spine  cut  in  half  to  show  the  groove  for  the  spinal 
cord.  The  three  spots  indicate  the  openings  where  the  spinal  nerves  pass  out.  No- 
tice the  network  of  ligaments  or  bands  that  bind  the  vertebrae  together. 

very  tender  also,  and  gentle  treatment  was  given  them  every  time.  With- 
in less  than  a  month  the  arm  was  in  apparently  perfect  condition,  the 
back  and  hips  began  to  get  some  strength,  and  in  about  six  weeks  he  could 
sit  propped  up  in  bed.  Sleep  improved  every  treatment  and  within  a 
couple  of  weeks  was  sleeping  normally,  though  had  to  be  turned  often 
the  first  ten  days  or  two  weeks;  each  treatment  made  his  rest  longer  be- 
tween being  turned  until  he  could  sleep  all  night  long  and  could  turn 
himself  after  couple  of  months'  treatment.  His  general  health  by  that 
time  was  almost  perfect.  It  was  about  four  months  until  he  could  sit 
unsupported  on  the  table,  and  until  he  could  take  a  very  thorough  treat- 
ment of  any  strength,  while  at  present  he  is  taking  a  very  strong  treat- 
ment. The  right  leg  has  been  the  worst,  and  atrophy  more  pronounced. 
He  can  crawl  on  the  floor  and  onto  the  couch  and  turn  a  somersault. 
Wiggles  the  toes  and  foot  slightly  of  left  leg,  but  only  faintest  indication 


130  POLIOMYELITIS 

of  motion  in  the  right  foot.     Improvement  still  continues  but  is  some 
slower  than  at  first,  as  was  expected. 

Case  46. — D.  D.,  age  5  years.  Taken  with  what  was  diagnosed  as 
autointoxication.  Left  arm  and  leg  were  affected  the  third  day,  the  arm 
but  slightly,  and  the  leg  more  severely.  M.  D.  thought  she  had  made 
good  recovery,  and  said  he  would  call  up  on  'phone,  though  he  thought 
further  calls  unnecessary.  Family  became  alarmed  at  the  paralytic  con- 
dition so  thought  of  Osteopathy.  I  pronounced  it  infantile  paralysis, 
and  told  them  to  isolate  the  case.  Recovery  of  all  trouble  seemed  good 
save  for  paralysis.  Muscular  atrophy  developed  in  the  leg,  of  half  an 
inch,  measured  3  inches  above  patella;  cervical  hyperesthesia  most 
pronounced. 

Treatment  daily  for  ten  days,  then  alternate  days  for  two  weeks, 
then  twice  weekly  for  six  weeks.  The  arm  became  normal  within  ten 
days,  the  leg  and  back  improved  steadily  so  could  stand  on  both  feet 
inside  two  weeks,  could  walk  in  three  weeks;  eversion  of  foot,  and  foot 
drop  was  overcome  in  six  weeks  and  discontinued  treatment  thinking 
the  child  cured.  I  urged  them  to  bring  her  once  weekly  for  two  months 
longer,  but  they  hated  to  part  with  "der  gelt,"  and  thus  economized. 
Case  was  generally  considered  cured  by  others,  though  I  told  them  it 
was  not  yet  complete,  for  when  tired  from  overstrain  at  play  the  limp  is 
quite  apparent.  They  took  the  child  to  the  family  doctor  to  show  them 
her  cured  condition,  but  he  grunted  that  "she  only  had  a  slight  touch  of 
it,"  notwithstanding  she  could  not  sit  alone  nor  stand  alone  when  he 
ceased  visits. 

Case  47. — P.  L.,  age  4  months,  also  pronounced  autointoxication. 
Family  doctor  only  made  a  couple  of  calls,  did  not  consider  the  babe 
was  in  a  serious  condition,  and  it  seemed  to  be  well,  though  parents 
noted  it  failed  to  move  one  leg. 

The  father  stopped  me  in  the  road  one  day  a  couple  of  weeks  after 
the  doctor  quit  the  case,  though  they  had  gone  to  his  office  telling  them 
they  feared  infantile  paralysis.  He  scouted  the  idea;  but  I  told  the 
father  I  was  satisfied  it  was  infantile  paralysis.  He  asked  me  if  I  could 
help  it,  and  I  assured  him  that  the  results  generally  were  good,  but  urged 
early  treatment  which  he  promised  to  start  at  once.  Opposition  pre- 
vented for  some  time,  so  it  was  over  a  month  from  onset  until  they  brought 
the  baby  to  me.  Atrophy  of  the  right  leg  was  most  pronounced,  half 
an  inch  at  the  calf  and  3-4  inch  two  inches  above  patella. 

Tho  child  had  appeared  most  robust,  it  has  had  chronic  constipation, 
kidney  and  stomach  trouble.  Hyperesthesia  localized  at  the  lumbar 
enlargement. 


CASE  REPORTS 


131 


Treatment  given  to  the  dorsal  and  lumbar  areas  thrice  weekly  for 
one  month,  then  twice  weekly  for  five  months.  Recovery  was  slower 
than  those  cases  taking  treatment  earlier.  Muscular  atrophy  not 
entirely  overcome  but  much  improved,  can  use  the  leg  considerably  and 
bears  weight  upon  it  now.  Constipation  has  been  most  obstinate  indeed. 
Expected  it  to  improve  with  little  attention  to  it  but  got  no  improvement 


FIG.  74.  The  tonsils  are  located  in  the  region  of  the  Eustachian  tubes  that 
connect  the  back  of  the  throat  with  the  middle  ear.  Each  tonsil  is  supplied  with  at 
least  four  arteries.  Good  drainage  prevents  congestion,  and  sometimes  partial  deaf- 
ness. Keeping  the  tonsils  normal  helps  to  prevent  the  entrance  of  germs. 


132  POLIOMYELITIS 

until  I  gave  it  more  direct  treatment,  and  now  the  general  health  is  the 
best  it  ever  had. 

The  furnace  allows  the  home  to  be  very  drafty,  and  many  severe 
colds  have  hindered  more  rapid  recovery.  I  expect  the  child  to  walk, 
though  there  will  likely  be  some  limp. 

Case  48. — E.  H.,  age  3  years.  Attended  by  same  physician  who 
advised  Osteopathy  in  first  case.  He  did  not  give  diagnosis,  but  said 
the  spine  was  affected  and  thought  Osteopathy  would  help  it.  The 
child's  neck,  shoulders,  left  arm  and  leg  were  badly  involved ;  he  could  not 
sit  up  so  was  carried  to  our  office. 

He  had  been  attacked  two  weeks  previously  and  they  supposed  it 
was  stomach  and  bowel  trouble  with  slight  fever.  In  the  cervical  and 
lumbar  enlargements  there  was  pronounced  hyperesthesia.  Very  gentle 
but  thorough  treatment  to  entire  spine  given  daily  for  ten  days,  then 
thrice  weekly  for  one  month,  then  twice  weekly  for  two  months. 

Sleep  during  or  following  treatment  almost  invariably  followed,  as 
in  nearly  every  case  treated.  Improvement  noted  from  the  first,  and 
treatment  gave  improvement  in  general  health  as  is  usual.  Kidneys  of 
most  cases  seem  to  be  in  poor  condition  and  improve  greatly  with  treat- 
ment. Ninety-five  per  cent,  of  the  treatment  is  to  the  spinal  area  and  I 
rely  upon  spinal  treatment  for  practically  all  results. 

The  arm  was  first  to  recover,  then  the  back,  then  the  leg  and  finally 
the  neck  so  patient  could  at  last  hold  the  head  up.  Three  months'  treat- 
ment made  practically  perfect  recovery  from  every  trace  of  paralysis, 
and  general  health  best  ever  enjoyed. 

Case  49. — G.  E.,  age  22  years,  living  sixteen  miles  from  here,  taken 
ill  soon  after  the  above  cases.  M.  D.  from  her  nearest  town  did  not 
attempt  to  name  the  disease;  no  one  thought  it  was  of  any  importance. 
The  M.  D.  did  not  have  to  make  but  one  or  two  calls,  fever  but  a  trace,  and 
recovery  seemed  O.  K.  after  couple  days  confinement  to  bed;  but  the 
left  arm  and  leg  did  not  act  right,  so  they  drove  in  to  see  me  a  few  days 
later.  I  used  a  meat  auger  and  Presbyterian  corkscrew  for  a  long  time 
to  get  a  history  of  the  case.  They  acted  as  though  they  were  in  a  den  of 
thieves,  but  had  no  better  place  to  go,  and  refused  to  give  symptoms  and 
history  I  wished;  I  finally  told  her  I  could  not  make  out  any  thing  but 
infantile  paralysis  from  her  reluctant  story.  I  advised  her  to  remain 
close  to  town  with  friends  and  have  frequent  treatment.  After  remain- 
ing all  night  with  their  friends  they  drove  home  the  following  day.  She 
was  again  taken  much  as  before  and  the  doctor  asked  for  consultation, 
when  they  told  him  they  had  been  here  and  I  pronounced  it  infantile 
paralysis.  They  quarantined  the  case  after  the  other  doctor  got  there, 


CASE  REPORTS 


133 


she  being  some  worse  than  the  first  time,  this  attack  lasting  a  week,  and 
the  paralysis  being  more  pronounced.  Roads  and  weather  prevented 
her  return  for  treatment  until  March  1st,  when  she  took  three  times 
weekly  when  possible.  The  right  leg  did  not  seem  atrophied,  and  she 
only  complained  of  sort  of  stiffness  and  weakness  in  that  ankle.  The 
atrophy  in  the  arm  and  leg  improved  as  did  function  until  the  left  leg 
seemed  normal  in  nutrition.  While  the  right  leg  did  not  improve  in 
size,  its  function  did  improve  considerably;  it  still  shows  atrophied  con- 
dition which  was  not  suspected  at  first.  This  is  unusual,  I  believe. 
Fifteen  treatments  have  been  given  altogether  with  improvement  suffi7 
cient  for  her  to  dispense  with  housekeeper's  services,  and  she  handles 
the  home  duties  very  nicely.  Can  get  the  arm  up  to  the  head  quite 
well  now,  walks  with  but  little  limp,  increased  in  weight  7  pounds, 
though  she  claimed  good  health  at  the  time  she  began  treatment.  Treat- 
ment will  be  continued  for  some  time  to  come,  with  less  frequency,  and 
with  expectations  of  further  gain. 


FIG.  75.  The  chest  is  hung  onto  the  spine,  and  fastened  together  at  the  front 
by  the  breast-bone.  As  we  breathe  this  cage  of  ribs  and  muscles  moves  upward  and 
<lo\vnward,  aiding  respiration. 


134  POLIOMYELITIS 

Case  50. — M.  E.,  age  17  years,  was  taken  ill  the  same  week  as  the 
first  four  mentioned.  Typhoid  fever  was  suspected,  from  digestive  tract 
symptoms,  by  attending  physician.  Grew  much  worse  for  couple  days 
when  he  had  a  consultation  with  another  M.  D.  and  they  thought  it 
was  brain  fever.  It  seemed  more  like  cerebrospinal  meningitis  than  it 
did  infantile  paralysis.  The  fifth  day  the  fever  and  delirium,  pain  in 
the  back,  neck  and  head  were  much  worse;  some  retraction  of  head,  and 
almost  total  blindness  for  a  day  or  so.  Little  hope  was  held  out  for 
recovery;  the  paved  street  was  roped  off  for  10  days  for  convulsions  were 
occasioned  by  noises  of  the  street.  Dr.  Gertrude  Gamble  (my  wife) 
was  called  at  this  period  and  worked  constantly  the  first  night,  ice  packs, 
and  treatment  occupying  her  time,  until  the  trained  nurse  arrived. 

Gentle,  inhibitory  treatment  was  given  to  the  entire  spinal  area 
thrice  daily  for  a  week,  twice  daily  for  a  week,  daily  for  two  weeks,  alter- 
nate days  for  a  month,  thrice  weekly  for  a  month,  and  twice  weekly  for 
a  month.  Six  treatments  were  given  the  next  two  months.  Opisthot- 
onos  and  convulsions  were  relieved  from  the  first,  fever  of  104.5 
responded  to  ice  packs  and  treatment.  None  of  the  previous  cases  showed 
so  high  temperature.  He  could  lie  in  no  position  save  upon  his  back  for 
some  days  before  treatment  was  instituted,  and  within  a  few  hours  he 
got  much  comfort  and  rest  when  enabled  to  change  his  position.  Sleep 
resulted  from  the  treatment  much  more  satisfactorily  than  from  opiates. 

Eyesight  slowly  improved  for  some  days  until  within  a  few  days  he 
could  recognize  objects,  though  it  was  some  months  until  oculist  thought 
it  wise  to  test  eyes  and  fit  him  with  glasses,  which  have  helped  him  quite 
a  little  and  his  condition  was  sufficiently  improved  by  January  to 
resume  high  school  work. 

Paralysis  was  not  noted  until  ill  a  week,  when  the  family  thought  it 
was  weakness,  and  did  not  wish  to  believe  it  was  anything  else.  The 
arms  and  shoulders  and  neck  were  mainly  involved,  though  whole  spinal 
group  of  muscles  were  slighly  involved,  and  when  convalescence  was 
well  advanced  he  could  not  sit  up  without  being  propped  up,  and  handled 
his  hips  poorly,  but  they  soon  recovered.  The  deltoids  and  triceps  were 
in  worse  condition  than  the  rest  of  arm  and  shoulder  muscles.  It  was 
two  months  before  he  could  comb  his  hair  or  raise  from  treatment 
table  without  holding  his  head  in  his  hand,  to  assist  it,  and  it  was  four 
months  before  it  was  not  an  effort  to  handle  the  head  and  neck. 

Santa  Barbara  mineral  waters  were  used  for  bowels  and  kidneys 
with  good  results  in  this  and  some  of  the  other  cases. 

As  the  patient  improved  the  strength  of  the  treatment  was  increased 
and  spine  was  sprung  throughout  as  much  as  prudence  permitted  each 


CASE  REPORTS 


135 


time,  and  nothing  but  good  resulted  therefrom.  Some  osteopaths  seem 
to  fear  to  do  much  more  than  spinal  massage;  from  experience  I  have 
proved  such  fears  to  be  unfounded.  A  typhoid  or  pneumonia  case 
demands  quite  as  much  caution  in  the  treatment  to  the  spine  as  poliomy- 
elitis, and  judgment  is  quite  as  essential  as  skill  in  the  proper  handling 
of  any  of  them,  if  they  are  very  alarming  in  their  nature,  but  the  more 
real  Osteopathy  they  get  the  more  flattering  your  results  will  be.  This 
case  recalled  that  he  had  made  a  visit  of  three  days  to  Great  Lakes  less 
than  a  month  previous  to  his  attack,  and  while  he  was  there  they  were 
having  an  epidemic  of  cerebrospinal  meningitis  that  was  serious,  and  in 


FIG.  76.  The  attachment  of  these  muscles  to  the  spine,  shoulder  blades,  collar 
bones,  and  head  assist  in  keeping  the  framework  in  perfect  alignment.  Paralysis 
weakens  them. 


136  POLIOMYELITIS 

which  I  lost  a  cousin  that  I  will  always  feel  might  have  been  spared,  had 
he  been  under  osteopathic  treatment. 

In  no  case  have  we  felt  there  was  any  benefit  from  drugs  previously 
administered,  and  in  no  case  do  we  wish  their  continuance.  We  have 
told  the  attending  physicians  in  cases  of  other  kinds  as  well  as  poliomye- 
litis, that  if  we  work  with  them,  a  placebo  suits  us  best  of  all  and  satisfies 
the  critics,  and  we  think  many  cases  have  received  placebos  when  the 
family  doctor  continued  to  make  occasional  calls.  A  dust-covered  high 
frequency  instrument  was  used  on  one  case  for  satisfaction  of  the  former 
doctor,  who  preferred  to  give  violet  rays  the  credit  rather  than  Osteo- 
pathy; fortunately,  much  improvement  was  shown  before  he  'phoned 
the  family  to  have  it  used.  I  could  not  see  that  its  use  was  of  value 
other  than  to  satisfy  all  that  everything  possible  was  being  done  to 
cure  the  case.  The  cure  I  believe  was  wholly  due  to  osteopathy. 


FIG.  77.  The  bones  of  the  pelvis  as  well  as  of  the  hips  are  all  bound  together 
with  ligaments.  Strains  and  twists  will  cause  these  side  bones  to  assume  a  new  posi- 
tion that  may  weaken  a  child. 

Diet  should  be  restricted  in  any  and  almost  all  cases  of  acute  ill- 
ness, but  otherwise  little  dependence  is  placed  upon  it  for  special  results. 
Exercise  in  early  convalescence  is  restricted,  but  later  on  is  encour- 
aged. Cases  which  have  neglected  taking  treatment  for  a  year  or  more 
will  generally  show  improvement.  One  bad  case  was  able  to  walk  with- 
out her  crutch  and  went  to  work  as  a  telephone  operator  when  she  had 
been  badly  crippled  in  both  legs  and  arms  for  two  years,  and  had  but 
two  months'  treatment  at  that. 


WALTER  GUTHRIDGE,  D.  O.,  Spokane,  Wash. 

Case  51. — Being  a  victim  of  poliomyelitis,  I  was  always  very  much 
interested  in  it  and  have  seized  every  opportunity  I  could  of  learning 
something  about  the  disease.  There  is  some  first  hand  knowledge  that 


CASE  REPORTS  137 

can  only  be  appreciated  by  a  victim.  I  can  readily  raise  the  toes  of  my 
right  foot;  but  as  to  the  left — I  cannot  even  try.  There  does  not  seem  to 
be  any  more  natural  motor  connection  between  me  and  the  toes  of  my 
left  foot  than  between  me  and  the  peninsula  of  South  America;  I  can  no 
nearer  try  to  raise  one  than  the  other. 

I  had  the  disease  when  two  and  a  half  years  old ;  and  after  the  age  of 
four,  as  the  right  leg  was  not  much  affected,  I  traveled  on  crutches  leav- 
ing the  left  leg  to  dangle,  until  I  was  eight  years  old.  I  kept  the  left  leg 
bent  at  the  knee,  until  I  could  not  straighten  it.  The  muscles  of  the  hip 
allowed  the  head  of  the  femur  to  draw  out  of  the  acetabulum  and  form  a 
joint  in  the  thyroid  foramen.  At  the  age  of  eight  the  lame  leg  was  two 
inches  short.  At  that  time,  I  began  to  wear  a  brace,  and  also  took  two 
years  of  vaccuum  treatment,  which  forced  circulation  into  the  limb  so  it 
grew  as  fast  in  length,  after  that,  as  the  other  leg. 

Case  53. — In  the  summer  of  1910  and  1911,  I  had  the  satisfaction  of 
attending  some  patients  in  the  acute  stage  of  the  disease.  One  of  them, 
a  nervous  boy  six  years  old,  and  very  small  for  his  age,  had  had  lagrippe 
during  the  previous  winter.  About  ten  days  before  his  sickness,  he  fell 
and  tumbled  end  over  end  down  a  steep  hill.  He  was  picked  up  a  little 
dazed  but  would  not  admit  that  he  was  hurt.  On  Saturday,  July  9,  he 
was.  taken  sick  and  his  right  leg  was  sensitive,  his  throat  was  sore  and  he 
had  some  fever  and  was  very  restless.  Appetite  was  good  on  Sunday 
and  Monday  forenoon.  On  Monday  afternoon,  he  had  nausea  and  was 
fretful.  He  walked,  but  back  and  legs  seemed  stiff. 

These  symptoms  were  reported  to  me  the  next  morning  by  a  rela- 
tive of  the  boy  who  was  taking  treatment.  I  recognized  the  disease  as 
poliomyelitis  and  advised  that  they  do  something  at  once.  I  told  the 
patient  to  keep  the  child  from  lying  on  his  back,  to  apply  cold  pack  to 
the  spine  and  thoroughly  cleanse  the  bowels.  I  hoped  they  would  call 
me  immediately;  but  a  negro  woman  neighbor  calmed  their  fears  and 
assured  them  he  would  be  all  right  in  a  day  or  two.  There  had  been 
constipation  from  the  beginning;  Syrup  of  Figs  had  been  given  on  Sun- 
day; there  was  but  very  slight  movement  of  bowels  on  Tuesday,  but  on 
Wednesday  they  thought  he  was  better.  On  Thursday  morning  he  was 
so  much  worse  that  a  neighbor  called  her  physician.  Paralysis  was 
present  and  the  doctor  recognized  the  disease  and  left  medicine.  Four 
big  doses  of  physic  were  given,  castor  oil  and  salts;  but  bowels  seemed 
paralyzed.  A  little  urine,  the  first  in  sixty  hours,  was  passed  at  four 
P.  M.  At  six  P.  M.  the  doctor  returned  and  found  patient's  head 
retracted.  He  diagnosed  the  condition  as  a  complication  of  poliomyelitis 
and  cerebrospinal  meningitis  and  gave  up  all  hope  of  the  child's  recovery. 


138 


POLIOMYELITIS 


I  was  then  called  and  arrived  at  seven  P.  M.  The  patient  was  only 
semi-conscious;  we  administered  an  enema  at  once  and  soon  secured  two 
copious  movements  of  the  bowels.  At  the  dorso-lumbar  region  for  a 
space  three  inches  long  and  one  inch  wide  arterial  pulsations  were  more 
forceful  and  prominent  than  I  had  ever  supposed  they  could  be  on  any 
part  of  the  body.  Muscles  along  the  spine  were  very  tense.  My  treat- 
ment consisted  principally  of  light  vibrations  over  dorso-lumbar  region. 
The  neck  muscles  soon  relaxed  and  the  patient  went  to  sleep.  About 
every  half  hour  during  the  night  he  would  become  restless,  but  gentle  pres- 
sure on  the  dorso-lumbar  region  would  quiet  him  and  he  slept  fairly  well 
during  the  night.  Temperature  was  101  degrees  on  Thursday,  and  did 
not  get  higher  afterwards;  breathing,  quick  and  short.  He  was  fed  a 
little  meat  soup  and  strained  oatmeal  gruel  but  had  no  appetite  till  Sun- 
day, July  17.  Treatment  was  continued  daily  for  two  months,  and  once 
a  week  for  four  months  longer,  when  a  brace  was  placed  on  his  right  leg 
and  he  began  to  walk. 

Nine  months  after  the  disease,  he  had  grown  at  least  six  inches  in 
height  and  almost  doubled  in  weight. 


I 


FIG.  78.  FIG.  79. 

FIG.  78.     The  normal  chest  is  conical  in  shape.     The  ribs  attach  themselves  to 
the  breast  bone  and  the  organs  are  well  protected. 

FIG.  79.     The  ribs  are  also  attached  to  the  spine  and  if  no  curvature  exists  they 
are  equally  spaced,  and  free  action  in  respiration  is  assured. 


CASE  REPORTS  139 

Atrophy  of  all  the  muscles  of  the  right  leg  was  very  marked  in  a  few 
weeks  after  the  disease.  He  never  regained  the  use  of  these  muscles. 
There  was  marked  stiffness  of  the  spine  during  the  disease  but  no  specific 
bony  lesions  that  I  could  discover.  The  relief  that  treatment  gave  the 
patient  during  the  acute  stage  deserves  notice;  light  manual  vibration 
was  the  treatment  that  afforded  most  relief. 

Case  54. — On  July  19,  1910,  I  was  called  to  see  a  child  three  and  a 
half  years  old  just  one  month  after  the  disease  began.  His  right  leg 
seemed  completely  paralyzed  from  the  gluteal  region  to  the  toes;  but 
there  was  very  little  atrophy.  I  treated  him  until  October,  when  he  be- 
gan to  walk  on  a  brace.  Six  months  later  he  discarded  the  brace. 

Case  55. — In  1909,  a  four-year-old  boy  fell  and  broke  his  arm  which 
was  put  into  a  cast.  While  the  arm  was  in  the  cast,  the  boy  had  a  dis- 
ease characterized  by  fever,  restlessness  and  stiffness;  but  the  doctors 
called  to  see  him  could  not  diagnose  the  case.  As  the  symptoms  subsided 
the  stiffness  persisted,  and  the  mother  diligently  required  the  child  to 
exercise  until  the  symptoms  passed  away.  When  the  cast  was  taken 
from  the  left  arm  it  was  found  that  every  muscle  of  the  arm,  the  exercise 
of  which  had  been  prevented  by  the  cast,  was  completely  paralyzed,  and 
they  have  never  improved.  The  hand  extended  beyond  the  cast  so  the 
fingers  could  be  moved  and  a  slight  motion  allowed  the  wrist;  just  those 
muscles  that  could  be  exercised,  and  no  others  escaped  paralysis.  The 
reflex  stimulation  of  muscular  activity  on  the  cells  of  the  spinal  cord 
saved  those  cells  from  destruction. 

The  germs  of  this  disease  are  so  small  that  they  readily  pass  through 
a  Berkfelt  filter.  It  has  been  proved  that  the  dust  from  the  carpet  and 
walls  of  the  sick  room  contain  the  germs,  which  may,  therefore,  be  dis- 
tributed widely  through  the  air.  And  it  is  also  known  that  the  disease 
occurs  in  light  form  and  may  never  be  recognized.  These  light  cases 
spread  the  infection  and  it  is  possible  that  many  healthy  people  may  act 
as  carriers;  thus,  the  disease  may  be  carried  long  distances  from  any  known 
case. 

The  germs  gain  access  to  the  body  through  the  nasal  mucosa  and 
during  the  incubation  stage  scatter  all  through  the  body  and  may  be 
found  in  nearly  all  or  all  of  the  tissues.  Nerve  cells  seem  to  be  the  least 
able  to  overcome  the  toxin  of  these  germs,  so  after  the  cells  of  the  most 
of  the  body  have  been  able  to  counteract  these  toxins  and  overcome 
the  germs,  the  germs  seem  to  concentrate  in  the  nervous  tissues  some 
place  where  they  have  not  met  so  much  opposition.  This  final  location 
of  the  germs  may  be  anywhere  in  the  spinal  cord  or  brain  where  some 
peculiarity  or  weakness  allows  the  germs  to  grow  more  virulent  until 


140 


POLIOMYELITIS 


their  toxins  tend  to  cell  destruction  of  the  nervous  tissue.  More 
frequently  than  anywhere  else  the  lumbar  enlargement  of  the  cord  is 
affected. 

The  extreme  hyperemia  and  capillary  pulse  beat  of  the  affected 
part  shows  nature's  gallant  effort  to  supply  that  location  with  blood  to 
overcome  the  disease.  The  white  blood  cells  congregate  in  great  num- 
bers and  are  found  just  outside  the  lumina  of  the  bloodvessels.  If  the 
hyperemia  is  not  very  active  the  white  blood  cells  may  accumulate  in 
such  numbers  that  by  pressure  they  occlude  the  lumina  and  thus  shut 
off  the  blood  supply. 

There  may  be  noticed  symptoms  of  a  cold  in  the  head,  fever  and  rest- 
lessness. Sensitiveness  of  some  part  of  the  body  may  early  indicate 
where  the  principal  trouble  is  going  to  be.  Stiffness  of  all  or  many  of 
the  muscles  of  the  body  is  perhaps  the  most  diagnostic  symptom.  All 
symptoms  may  be  so  slight  as  to  be  overlooked  until  paralysis  sets  in. 


Heart  ,  Lun§s.  *B*.  Important 
Utrve^,  And  Vessels. 


Stomach.,    Liver,   Kidney,. 
SpUen  ,    P«.ntTCcLs  ,     Large  A 
SiTioti    Intestxnes  ,«*•< 
Ar.4 


FIG.  80.     Framework  of  the  house  in  which  we  live. 
preventative  measure. 


Perfect  alignment  is  a 


CASE  REPORTS 


141 


In  other  cases  the  preliminary  symptoms  may  be  severe  and  no  perma- 
nent paralysis  take  place.  This  was  my  experience  in  at  least  one  case. 

In  cerebral  cases  the  symptoms  differ  very  widely  from  the  above. 
The  child  seems  to  prefer  lying  on  its  back  and  rolls  the  head  from  side  to 
side  or  remains  quiet.  Generally  the  patient  becomes  unconscious;  head 
is  not  retracted;  diarrhea  prevails,  while  constipation  is  the  rule  in  spinal 
cord  cases.  Cases  of  this  type  were  frequently  diagnosed  as  cerebral 
meningitis  previous  to  1910. 

Proper  treatment  during  the  acute  stage  may  do  a  great  deal  of  good 
and  help  the  patient  through  with  less  damage  than  he  could  expect  to 
!•<>(•(  ive  without  correct  attention. 

We  must,  in  order  to  assist  nature  in  overcoming  any  disease,  see 
what  nature's  method  of  fighting  this  disease  is,  and  aim  to  assist  in  just 


FIG.  81.  We  are  shorter  at  night  than  in  the  morning,  and  we  are  shorter  if  we 
stoop,  as  in  round  shoulders.  The  arrow  points  to  the  pads  between  each  section  of 
the  spine. 

the  line  nature  is  trying  to  act.  The  germs  gain  access  through  the  nasal 
mucosa  and  spread  all  over  the  body.  More  than  a  thousand  people 
are  exposed  to  every  one  who  is  susceptible  enough  to  suffer  noticeably 
from  the  disease.  Nearly  all  tissues  of  the  body  are  immune  from 
attacks  of  the  germs  and  readily  overcome  them.  Thus  these  tissues  easily 
manufacture  enough  antitoxin  to  kill  the  germs,  and  if  the  circulation  to 
every  cell  of  the  body  is  perfect  this  antitoxin  is  carried  to  every  cell 
and  the  germs  eradicated.  The  nerve  tissue  is  the  only  kind  that  may 
need  help  and  if  any  particular  part  of  the  nerve  tissue  is  specially  weak- 
ened, the  germs  at  that  point  grow  more  virulent  and  their  toxin  tend  to 
destroy  the  helpless  nerve  cells.  We  know  that  nerve  cells  that  are 
actively  functioning  can  put  up  a  strong  fight;  but  the  quiescent  ones 
are  much  more  likely  to  succumb.  It  is,  therefore,  the  duty  of  the  physi- 
cian and  nurse  to  allow  the  nerve  cells  to  have  all  the  needed  physiologi- 


142  POLIOMYELITIS 

cal  stimulation  that  muscular  activity  can  give  them.  Not  only  should 
the  circulation  through  the  nerve  tissue  be  kept  as  perfect  as  possible; 
but  we  should  be  sure  that  the  antitoxin,  which  every  other  tissue  of  the 
body  manufactures,  is  carried  promptly  into  the  circulation  and  thus 
brought  to  the  needy  nerve  tissue.  As  soon  as  the  disease  is  recognized, 
if  the  bowels  are  constipated  they  should  be  well  cleansed  with  enemas, 
and  treatment  begun. 

During  the  acute  stage,  the  child  should  be  put  into  a  bath  at  tem- 
perature of  about  103  to  105  degrees.  The  heat  helps  to  relax  the  con- 
tractured  muscles.  While  in  the  bath,  massage  should  be  given  to  thor- 
oughly stimulate  the  venous  and  lymphatic  circulation,  so  the  antitoxin 
made  by  the  body  cells  can  be  utilized  where  needed,  and  the  toxin  from 


FIG.  82.  Nature's  method  of  nourishing  the  spinal  cord,  its  membranes  and 
the  spinal  sections  called  vertebrae.  The  artery  sends  a  branch  into  the  opening 
where  the  spinal  nerve  comes  out.  Any  irregularity  of  the  spinal  column,  such  as  a 
curvature,  will  interfere  indirectly  with  the  artery  and  nerve,  also  a  vein  that  passes 
out  to  convey  away  the  impure  blood.  Each  spinal  segment  must  be  nourished  prop- 
erly or  else  the  nerves  suffer. 

the  disease  germs  disseminated  over  the  body,  to  more  fully  stimulate 
the  manufacture  of  antitoxin  by  the  stronger  tissues.  Every  muscle,  as 
far  as  possible,  should  be  exercised  passively  while  child  is  in  the  bath,  so 
that  the  nerve  cells  of  each  muscle  will  have  the  reflex  stimulation  of 
muscle  activity.  The  bath  and  treatment  should  last  ten  minutes  or 
more  and  be  repeated  about  every  two  hours,  or  even  oftener,  as  the  case 
requires. 

Careful  stretching  of  the  spinal  column  should  be  attended  to  to 
force  and  free  the  circulation  through  the  affected  part.  If  the  circulation 
is  kept  as  free  as  needed  through  the  cord,  the  accumulation  of  white 
blood  cells,  that  by  pressure  often  occlude  the  blood  vessels,  will  not  be 


CASE  REPORTS  143 

likely  to  take  place.  This  one  thing  is  most  essential.  Light  manual 
vibration  correctly  used  over  the  affected  area  between  the  times  for  the 
baths  and  treatment  will  also  help  to  this  end  and  relieve  the  patient 
very  decidedly. 

This  scheme  of  treatment  should  continue  during  the  whole  twenty- 
four  hours  of  each  day  during  acute  stage.  It  is  during  the  quiet  hours  of 
night,  while  the  patient  is  more  quiet  than  usual,  that  damage  is  most 
liable  to  be  done.  Do  not  let  the  child  lie  on  his  back;  turn  him  over  as 
often  as  he  desires.  The  limb  or  limbs  paralyzed,  or  threatened,  should 
be  frequently  moved  for  the  sake  of  the  reflex  effect  on  the  nerve  centers. 

After  the  acute  stage  is  over  treatment  should  be  continued  until 
the  body  is  in  the  best  possible  shape.  Where  the  muscles  are  atrophied 
a  few  weeks  after  treatment,  it  is  good  evidence  that  the  nerve  cells  gov- 
erning those  muscles  are  either  dead  or  very  weak.  Other  nerve  cells 
may  act  on  those  muscles  but  the  dead  cells  cannot  be  regenerated  by 
any  means  at  our  command.  The  weakened  muscles  can  be  strength- 
ened by  special  exercises  designed  for  each  case.  Surgery  is  sometimes 
indicated. 

Susceptibility  seems  greatest  during  the  second  and  third  years  of 
life.  The  youngest  patient  I  have  known  was  eleven  months,  and  the 
oldest  nearly  seventy  years.  In  experiments  on  monkeys,  practically 
every  monkey  was  susceptible  by  inoculation,  but  I  have  seen  no  report  of 
any  monkey  taking  the  infection  in  a  natural  manner.  It  was  proved 
that  immunity  as  a  rule  resulted  from  once  having  had  the  disease. 


M.  D.  Commends  Osteopathtc  Treatment 

It  is  a  great  satisfaction  to  the  Osteopathic  Magazine  to  be  able  to 
present  to  its  readers  a  report  by  F.  Fisher,  B.  A.,  M.  D.,  of  Curling, 
Newfoundland,  on  his  experience  last  year  with  three  cases  of  poliomye- 
litis (infantile  paralysis)  in  which  he  gives  frank  credit  to  the  treatment 
of  an  osteopathic  physician.  Statements  of  this  character  from  medical 
practitioners  are  so  rare  that  they  have  a  really  unique  interest. 

Referring  to  the  cases  of  Frank  Meaney ,  7  years  old ;  Gordon  Meaney , 
5  years  old,  and  their  sister,  May,  11  months  old,  Dr.  Fisher  says,  in  a 
statement  that  was  read  at  the  annual  convention  of  the  American  Os- 
teopathic Association  in  Boston  the  first  week  in  July: 

"At  first  I  thought  I  had  a  case  of  cerebro-spinal  meningitis.  When 
paralysis  developed  and  muscles  began  to  show  wasting,  together  with 
absence  of  deep  reflexes  and  acute  onset,  the  malady  impressed  itself 
upon  me  as  cases  of  anterior  poliomyelitis. 


144  POLIOMYELITIS 

"Two  days  before  the  death  of  the  second  child  I  was  fortunate  in 
securing  the  services  of  Dr.  Philip  Holliday,  an  osteopathic  physician  of 
Montreal — fortunate  as  regards  diagnosis  and  more  so  respecting  treat- 
ment. Realizing  the  great  and  lasting  benefit  given  some  patients  of 
mine  I  had  him  treat  two  months  previous,  I  gladly  gave  Dr.  Holliday  a 
free  hand  in  the  treatment  of  these  cases  of  infantile  paralysis.  I  was 
interested  to  see  how  he  could,  by  his  manipulative  method,  relieve  con- 
gestion of  the  brain  and  spinal  cord. 

"That  he  did  so  relieve  pressure  was  proved  by  the  fact  that  while 
the  child  was  in  a  state  of  convulsions  he  would  administer  his  treatment 
but  a  very  short  time  when  the  convulsions  would  cease,  and  the  little 
boy  would  be  able  actually  to  recognize  his  own  parents.  This  occurred 
not  only  once,  but  if  I  remember  rightly  some  half  dozen  times.  It 
seemed  to  me  that,  had  Dr.  Holliday  been  two  days  earlier,  he  could  have 
saved  this  child's  life  also.  His  treatment  in  the  cases  of  the  oldest  boy 
and  the  baby  was  most  effective.  In  the  case  of  the  brother  it  restored 
his  right  leg  to  normal  condition,  and  I  believe  arrested  the  disease  in  the 
left.  The  little  sister  shows  no  ill  effects  whatever  of  the  paralysis  of  the 
arm,  and  the  boy,  apart  from  a  slight  limp,  which  is  weekly  improving, 
is  able  to  move  freely  about  and  play  again  with  his  companions. " 


Club  Foot  Follows  Infantile  Paralysis 

GEO.  M.  LAUGHLIN,  D.  O.,  Orthopedic  Surgeon 

This  is  a  case  of  acquired  club  foot  due  to  infantile  paralysis.  The 
patient  is  22  years  of  age.  She  gives  the  following  history: 

When  two  years  old,  she  had  an  attack  of  infantile  paralysis,  and 
she  recovered  from  the  attack,  except  she  has  paralysis  in  the  left  leg 
and  foot.  In  the  beginning  there  was  paralysis  of  both  legs  and  involve- 
ment of  one  or  both  arms,  although  eventually  recovery  was  complete 
except  in  the  left  leg. 

This  case  presents  some  very  interesting  features  because  there  is  a 
deformity  here  which  would  persist  unless  certain  things  are  done.  This 
case  will  respond  to  Orthopedic  treatment.  She  says  that  an  operation 
was  performed  about  six  years  ago,  which  operation  is  what  we  would 
ordinarily  do  for  dividing  the  plantar  fascia  or  the  tendo  Achilles.  She 
wears  a  brace  to  hold  the  foot  normal,  or  as  nearly  normal  as  it  will  go. 
Here  is  the  brace  this  patient  wears.  It  is  cumbersome.  You  see  it  is 
heavy;  she  is  troubled  in  putting  it  on  and  taking  it  off.  She  walks  poorly 
with  this  brace  because  the  tendo  Achilles  is  too  short.  She  walks  on  her 
toe  in  advancing. 


CASE  REPORTS  145 

I  will  not  discuss  in  this  case  the  treatment  for  infantile  paralysis, 
that  is  its  cause,  symptoms,  and  treatment  for  the  acute  stage.  Here  is 
a  case  that  has  long  since  passed  the  acute  stage  and  is  characterized  by 
paralysis  of  certain  muscles  which  has  resulted  in  a  definite  deformity  and 
can  only  be  corrected  by  certain  definite  methods  of  treatment.  In  order 
to  determine  what  might  be  done,  we  have  to  take  into  consideration  the 
muscles  of  the  thigh,  back  and  buttocks  and  see  to  what  extent  the  mus- 
cles are  paralyzed.  If  the  muscles  of  the  legs,  thighs  and  buttocks  are  com- 
pletely paralyzed  nothing  can  be  done.  If  only  certain  groups  of  muscles 
are  paralyzed,  and  other  muscles  remain  in  nearly  normal  strength,  we 
can  do  certain  things  which  will  eliminate  the  necessity  of  wearing  ap- 
paratus and  which  will  at  the  same  time  permanently  correct  the  de- 
formity. 

In  looking  over  this  case,  I  find  no  paralysis  of  the  spinal  muscles. 
Both  gluteal  muscles  are  about  the  same.  There  is  strength  in  the 
gluteal  muscles  on  the  left  side.  If  the  gluteal  muscles  are  paralyzed, 
they  would  be  very  poor.  The  body  would  protrude  when  weight  is  put 
upon  the  muscle.  You  can  see  that  as  I  step  on  my  right  leg  and  the 
left  is  off  of  the  floor,  I  stand  erect.  If  the  left  muscle  was  paralyzed, 
the  body  would  protrude. 

Now  I  will  next  test  the  flexors  and  extensors  of  the  thigh.  In 
order  to  do  that,  I  will  have  her  sit  up.  Now  I  will  have  the  patient  ex- 
tend her  leg.  See,  she  can  extend  the  leg.  Now  with  the  leg  extended, 
I  will  see  if  I  can  push  it  down.  See,  I  can  hardly  push  it  down.  We 
know  she  has  got  strength  in  the  quadriceps  extensor.  When  it  is  para- 
lyzed, the  patient  will  walk  putting  the  foot  down  carefully,  and  unless 
there  is  the  proper  balance,  the  patient  will  go  down  because  the  quad- 
riceps extensor  is  not  strong  enough  to  maintain  the  leg  in  proper  posi- 
tion. 

Now  I  shall  test  the  hamstrings.  I  will  have  the  patient  draw  her 
leg  back  and  see  if  I  can  straighten  it.  See,  the  hamstrings  are  normal. 
So  the  flexors  and  extensors  are  normal. 

Next,  we  come  to  the  foot  and  the  leg.  Now  you  can  see  she  has 
talipes  equina  varus.  Talipes  is  due  to  contraction  of  the  tendo  Achilles. 
You  will  notice  the  foot  turns  in.  That  is  due  to  some  contraction  of  the 
tibialis  anticus,  which  remains  good,  and  to  paralysis  of  the  peroneal 
muscles.  The  tibialis  anticus  is  not  sufficiently  opposed  to  keep  the  foot 
in  normal  position.  It  is  not  only  a  flexor  muscle  but  turns  in  (inverts) 
the  foot  as  well.  She  can  flex  the  foot  normally.  She  can  riot  flex  the 
foot  out  (evert)  as  the  peroneal  muscles  are  paralyzed.  She  has  a  good 
gastrocnemius,  fairly  good  tibialis  anticus,  but  the  peroneal  is  paralyzed. 


146  POLIOMYELITIS 

There  are  two  operations  for  this.  First,  I  will  mention  one.  There 
is  one  operation  which  will  give  this  patient  a  good  foot.  You  know 
treatment  won't  do  it,  for  she  has  had  the  condition  too  long.  Where 
some  of  the  muscles  are  paralyzed  and  some  are  healthy,  we  figure  out  a 
plan  whereby  we  can  transpose  a  healthy  muscle.  Where  the  tendon 
transplantation  is  indicated,  you  have  to  have  some  good  muscles.  We 
can  transpose  the  tibialis  anticus  from  the  inside  to  a  little  past  the 
middle  of  the  foot.  The  tendon  is  inserted  into  the  bone  by  dividing  the 
periosteum  and  making  a  groove  in  the  bone  so  the  tendon  will  lay  in 
there.  Of  course,  I  will  flex  the  foot  around  a  little  over-corrected  be- 
fore planting  the  tendon.  I  will  then  apply  a  cast  and  a  suitable  sup- 
port. If  the  support  is  not  worn  long  enough,  it  may  come  loose.  Slit- 
ting the  tendo  Achilles,  we  can  flex  the  foot  up  and  there  is  no  danger  of 
secondary  contraction.  If  it  is  divided  across,  it  will  go  together  again 
and  contract.  Make  an  incision  down  the  tendo  Achilles  and  splice  it, 
and  we  don't  get  a  secondary  contraction.  Having  transposed  the  tibialis 
anticus  from  the  inside  to  the  outside  of  the  foot,  she  should  be  able  to 
flex  and  extend  the  foot,  and  should  be  able  to  go  about  without  a  brace. 
Suppose  she  did  not  have  a  good  tibialis  anticus  or  had  very  little  power 
of  contraction  but  had  a  good  flexor  of  the  great  toe.  I  could  take  that 
just  the  same.  Taking  off  the  tendon  of  the  great  toe,  pulling  it  up  and 
passing  it  down  outside  the  foot  it  would  be  good.  What  else  could  I 
do?  I  could  fix  the  ankle.  I  would  go  into  the  joint  here  and  ankylose 
it  by  taking  off  the  cartilage  of  the  astragalus  and  tibia  and  getting  fusion 
of  the  bones. 

Notes  on  Infantile  Paralysis  Cases 

EVELYN  R.  BUSH,  D.  O.,  Louisville,  Ky. 

"Many  cases  of  paralysis  have  been  restored  to  comparative  effi- 
ciency by  Osteopathy,  after  all  other  methods  failed, "  said  Dr.  Bush. 

"I  will  not  enter  needlessly  into  anatomical  or  pathological  findings, 
but  at  once  take  you  into  the  realms  of  re-education  of  muscles,  where 
long  and  unusual  experience  has  furnished  me  with  interesting  and  won- 
derful data. 

"The  technique  to  be  pursued  in  the  re-education  of  muscles  in 
paralysis  is  a  subject  upon  which  practically  no  literature  has  been 
written. 

"We  have  not  enough  osteopathic  physicians  to  meet  the  demands 
for  osteopathic  work,  hence  they  have  so  little  time  for  writing,  while  the 
physicians  of  other  schools  have  so  little  constructive  treatment,  as  yet, 
to  give  to  the  world  on  the  subject. 


CASE  REPORTS  147 

"A  detailed  account  cannot  be  given  at  this  time,  of  our  various 
methods  of  ascertaining  the  loss  or  impairment  of  power  of  individual 
muscles  or  groups  of  muscles.  A  knowledge  of  the  origin  and  insertion, 
nerve  supply  and  normal  action  of  a  muscle  or  group  of  muscles,  gives 
the  ability  to  work  out  according  to  the  type  of  individual  under  treat- 
ment, the  series  of  tests  or  experiments  necessary  to  gain  the  desired  in- 
formation. 

"While  we  are  cautious  to  be  accurate  in  our  physical  findings,  we 
recognize  the  unlimited  importance  of  our  mental  findings.  One  of  our 
important  duties  is  to  secure  the  best  mental  atmosphere,  for  without  it 
our  work  will  be  far  less  rapid. 

"There  is  more  or  less  fear  present  in  the  mind  of  every  paralytic 
case.  This  must  be  eradicated  at  the  earliest  possible  moment.  The 
physiological  effect  of  fear  in  these  cases  receives  all  too  little  attention 
within  our  ranks. 

"It  is  of  paramount  importance  to  see  what  is  the  stage  of  develop- 
ment of  the  will  of  the  individual.  What  the  steam  is  to  the  engine, 
so  the  will  is  to  the  paralytic — an  absolute  necessity." 

"The  physiological  power  of  'interest'  is  as  yet  an  unknown  subject 
in  connection  with  these  cases.  It  has  been  said,  'If  a  man  expended  the 
same  amount  of  muscular  exertion  sawing  wood,  which  he  does  climbing 
rocks  and  wading  streams  after  trout,  he  would  faint  dead  away.'  But 
interest  is  the  soul  of  will.  Therefore,  see  that  you  have  the  patient's 
interest.  There  is  nothing  more  deplorable  than  the  pathetic  look  in 
the  faces  of  most  of  the  paralyzed  patients  and  their  relatives.  Why? 
Not  the  disease  itself,  for  you  know  running  down  the  category  of  dis- 
eases there  are  many,  many  diseases  worse  than  paralysis.  Why?  I 
answer — because  of  the  discouraging  words  humanity  was  accustomed  to 
use  relative  to  paralysis  before  Dr.  Still  gave  Osteopathy  to  the  world — 
Helpless,  hopeless,  incurable  cripple!  Words!  enduring  words!  How 
they  sink  into  the  mind  and  what  havoc  is  wrought  by  them! 


CHAPTER  9 

Osteopathic  Treatment  Versus  Medical 
Treatment  of  Infantile  Paralysis 

E.  FLORENCE  GAIR,  D.  O.,  Brooklyn,  N.  Y. 

Since  I  have  explained  my  objection  to  the  use  of  the 
case  and  the  brace  (they  both  retard  and  hinder  nature  in 
her  effort  to  re-establish  normal  physiological  functioning 
to  the  affected  parts  by  impeding  the  circulation),  in  like 
manner  I  will  try  to  explain  why  I  object  to  the  medical 
regime  in  handling  this  disease. 

Infantile  paralysis  is  not  like  an  acute  tubercular  in- 
fection to  a  bony  part  that  at  once  requires  rest  and  immo- 
bility to  the  affected  area;  instead,  this  is  a  disease  that  urges 
the  quickest  ridding  in  the  system  of  the  toxemia  being  formed 
and  this  at  the  earliest  moment. 

In  all  acute  diseases  we  osteopathic  physicians  work 
with  the  idea  of  helping  nature  to  regain  her  own  balance  to 
do  the  work;  we  therefore  free  up  the  circulation  wherever 
impeded,  and  likewise  the  nervous  system,  thus  permitting 
the  cells  to  regain  their  normal  tone  throughout.  We  help 
the  system  to  eliminate  the  toxins  being  formed  by  improv- 
ing the  action  of  the  skin,  the  kidneys  and  the  bowels.  I 
believe  had  every  case  been  given  the  following  treatment 
many  a  life  might  have  been  saved  and  many  a  limb  regained 
its  functioning.  As  the  disease  generally  starts  with  a  mu- 
cous infection  in  the  head  I  employ  a  gargle  of  hot  water  and 
vinegar — a  tablespoonful  to  a  half-glass — this  cuts  the 
phlegm  and  cleanses  the  membrane,  then  I  have  the  nos- 
trils rinsed  with  a  mild  antiseptic — very  mild  though — fol- 
lowed by  an  oil  spray  or  melted  white  vaseline.  This  spray- 
ing and  gargling  can  be  done  every  few  hours.  The  infec- 
tion passes  down  the  mucous  membrane  to  the  bowels, 
therefore  a  thorough  cleansing  with  water — no  medicine  yet 
ever  cleansed  the  colon — it  merely  makes  a  centre  clearing, 
leaving  the  accumulation  around  the  colon  wall.  This  water 
bath  to  the  colon  greatly  helps  in  diluting  the  toxemia.  I 
use  a  cup  of  steeped  strained  flaxseed  for  bad  cases,  or  oils; 


150  POLIOMYELITIS 

milk  of  magnesia  is  excellent,  or  bi-carbonate  of  soda,  or 
anything  of  that  nature  that  will  not  injure  the  mucous  mem- 
brane. I  always  use  the  Cole's  Metal  Sigmoid  irrigator— 
it  is  so  easily  inserted  and  stays  when  it  is  put  at  the  mouth 
of  the  descending  colon.  I  can  then  use  as  much  water  as 
I  feel  I  need  with  no  expelling  or  displacement  of  the  tube 
on  the  evacuation  of  the  fluid  contents.  The  rubber  tube 
must  be  reinserted  at  every  expulsion  of  water  and  must 
cause  an  irritation  in  the  end  of  the  mucous  membrane  if 
continually  reinserted.  The  wash  out  is  never  so  quickly 
done  or  so  thorough.  I  follow  up  the  irrigation  with  a  hot 
bath — from  which,  undried,  I  wrap  the  child  in  a  blanket 
and  put  him  to  bed  with  hot  water  bottles  to  get  well  bathed 
in  perspiration.  If  the  fever  does  not  abate — compresses 
around  the  abdomen  are  used.  Later  a  good  massage  with 
hot  oils  and  a  little  alcohol.  This  frictional  rubbing  helps  to 
rid  the  muscle  toxins,  and  so  helps  the  nervous  tone.  Noth- 
ing is  given  to  eat,  but  all  the  water,  hot  or  cold,  the  child 
will  drink  with  a  fruit  juice  added,  preferably  lemon  without 
sugar,  the  first  day.  This  helps  to  keep  up  the  dilution  of 
the  toxins  by  eliminating  through  the  kidneys.  Every 
mother  that  attends  my  clinics  is  taught  this  procedure  in 
handling  a  fever.  It  gives  them  confidence  and  keeps  them 
from  that  panicky  feeling  as  soon  as  a  child  looks  ailing. 

In  the  recent  epidemic  of  "Flu"  I  did  not  lose  a  single 
case.  I  simply  instructed  each  parent  what  to  do,  and  when 
able  the  patient  came  to  me  for  treatment.  No  complica- 
tions set  in,  and  no  after  results.  What  is  it  but  just  com- 
mon sense,  and  had  this  method  been  instituted  in  the  army 
many  a  boy  might  have  been  saved.  Many  a  disease  can 
be  readily  checked  at  the  outset  by  this  rational  method  of 
handling,  as  most  children's  diseases  either  start  with  a  cold 
in  the  head  or  an  upset  intestinal  tract.  It  is  the  common- 
sense  method.  The  medical  treatment  for  infantile  paralysis 
was  rest  and  a  cathartic — a  rest  of  a  six  weeks'  period  and  then 
electric  treatment  or  massage.  In  the  meantime  the  tox- 
emia has  overwhelmed  the  cells  in  the  spinal  column.  The 
only  sane  feature  of  their  treatment  was  that  of  massage. 
Those  children  who  had  that,  were  best  off  for  it  helped  na- 
ture most — but  even  in  those  cases,  WHEN  DEFINITE  BONY 
LESIONS  PERSISTED  that  limb  was  cut  off  from  its  normal 


OSTEOPATHIC  TREATMENT  vs  MEDICAL  TREATMENT  151 

blood  and  nerve  supply  and  could  not  regain  its  tone,  and 
that  is  why  such  astounding  results  take  place  under  osteo- 
pathic  care.  The  lesions  are  reduced  permitting  normal 
stimuli  of  nerves  and  blood  flow  through  the  limb. 

Lately  I  had  a  twelve-year  old  boy  brought  me  from  a 
medical  hospital  where  he  had  been  treated  since  1916. 
They  had  kept  him  on  a  Bradford  frame  for  a  WEAK  BACK. 
The  condition  was  pitiful.  He  was  stiff  as  a  board  all  over 
and  very  painful  to  the  touch,  a  bad  lumbar  curve  had  form- 


FIGS.  83-84.     A  complete  right  side  paralysis  with  loss  of  speech  cured  in  four  treat- 
ments.    Boy  today  is  in  perfect  condition.     (See  Chapter  7,  p.  71.) 

ed,  and  a  resulting  compensating  one  above,  the  limbs  in 
contraction,  skin  so  harsh  and  badly  nourished.  In  a  few 
weeks  I  revolutionized  him.  He  comes  in  smiling,  the  fam- 
ily are  so  happy  for  they  begin  to  see  hope  for  recovery. 
The  special  curves  are  gradually  disappearing.  The  con- 
tractures  are  giving  way,  the  skin  is  improving,  and  the 
boy  is  happy.  An  uncle  brings  him  Sunday  and  a  young 
boy  for  the  Wednesday  treatment.  What  the  resultant 
effects  would  have  been  had  the  Bradford  frame  been  em- 


152  POLIOMYELITIS 

ployed  much  longer  is  easy  to  conjecture.  Yet  these  poor 
people  paid  $3.00  per  week  for  two  years  for  WHAT? 

Another  case  similar — a  twelve  year  old  boy  had  been 
left  in  a  hospital.  Last  June  the  parents  brought  him  to  me. 
They  took  him  home  for  they  saw  him  getting  worse  instead 
of  better.  The  mother  had  a  good  supply  of  common  sense 
and  began  massage  and  muscle  exercise.  I  gave  three  treat- 
ments before  I  left  for  the  summer  and  this  September  on 
my  return  I  was  indeed  happy  with  the  change.  The  father 
picked  up  a  Ford  car  for  $50.00,  which  he  repaired,  and  the 
boy  has  had  good  airing  since.  He  is  certainly  progressing 
each  month,  and  yet  these  cases  seem  so  pathetically  hope- 
less when  you  first  see  them. 

This  fall  I  had  the  good  fortune  to  get  a  baby  stricken 
this  September.  The  case  was  never  diagnosed  Infantile 
Paralysis,  but  the  mother  kept  noticing  how  unstable  the 
child  was  when  walking,  how  it  would  drop  suddenly  after  a 
few  steps;  I  told  her  that  without  a  doubt  it  was  a  case  of 
poliomyelitis.  The  limbs  toned  up  into  firm  hard  flesh  and 
the  baby  walked  nicely  after  three  treatments. 

One  of  my  girls  who  came  to  me  two  years  ago  with 
weak  ankles — she  couldn't  then  walk  two  blocks  without 
fatigue — hiked  seven  miles  this  summer.  Her  case  is  one 
from  infancy.  I  always  feel  proud  of  results  from  these 
long  standing  cases,  and  I  am  still  wondering  how  that  mus- 
cle tone  and  strength  of  limb  is  obtained  after  all  these  years. 
How  do  we  do  it?  Do  we  establish  new  pathways  for  a 
nerve  cell  that  dies?  Is  it  resuscitated?  Or  do  we  get 
other  nerves  to  take  up  the  functioning  of  the  dead  nerve? 
These  cases  get  better  and  better  each  year.  Nature  abhors 
a  vacuum.  It  is  the  mutual  effort  I  believe.  It  is  the  energy 
and  mental  stimulus  of  those  treating  the  disease  imparted 
to  the  child's.  The  more  mental  effort  and  energy  the  child 
uses  the  better  the  child  gets.  Each  year  I  treat  this  dis- 
ease I  feel  more  and  more  the  wonderful  something  we  each 
possess  that  is  at  our  call  if  we  only  understand.  The  Lord 
helps  those  who  help  themselves. 

Nature  has  within  her  resources  unlimited  processes, 
but  one  must  go  along  with  her  and  not  against  her.  She 
needs  our  assistance  both  mental  and  physical. 


OSTEOPATHIC  TREATMENT  vs  MEDICAL  TREATMENT 


153 


I  notice  in  my  work  that  the  mothers  who  never  say 
die,  who  won't  give  up  a  case,  accomplish  wonders  in  this 
disease.  It  is  truly  remarkable  what  some  of  these  mothers 
accomplish.  I  have  one  mother  in  mind.  She  took  a  help- 
less boy  of  three  from  the  hospital  in  a  pitiful  condition — the 
last  doctor  gave  her  no  hope — told  her  the  case  was  hopeless. 
She  never  knew  how  she  pushed  the  baby  home  she  was  so 
dazed.  When  she  came  to  herself  she  determined  she  would 
not  give  her  boy  up.  She  started  in  massage  and  muscle 
exercises,  she  made  up  all  sorts  of  exercises.  It  was  remark- 
able the  change  in  six  months,  and  since  bringing  him  to  me 
the  reconstructive  progress  has  been  steadily  going  onward. 

I  never  forget  to  instil  into  these  patients,  never  to  give 
up,  to  keep  on  and  on,  till  each  year  brings  the  child  nearer 
perfection. 

November,  1918. 


FIG.  85.  Author's  case  of  infantile 
paralysis  now  completely  restored. 
For  three  years  I  have  been  raising 
rabbits  to  give  my  clinic  cases,  and 
with  good  results.  I  find  that  the 
rabbits  absorb  their  interest  and  in 
their  effort  to  catch  them,  they  forget 
their  affliction  and  exert  every  ounce 
of  energy  possible  to  capture  them. 
This  exercises  the  muscles. 


INDEX 

Page 

A  hard  fight  in  some  cases  (case  20) 102 

A  careful  history  is  to  be  commended  (case  18) 101 

A  case  practically  cured  after  twelve  years 66 

A  quick  recovery 78 

Abortive  type  of  infantile  paralysis 32 

Abortive  type  of  infantile  paralysis  (case  18) 101 

Accidents  to  babies  in  arms 8 

Accidents  a  factor  in  causing  infantile  paralysis 61 

Acute  cases 48 

Adenoids  lower  resistance  of  respiratory  membranes  to  infection ....  28 

Adjustment  lowers  temperature 35 

Adjust  rapidly  in  children 45 

All  acute  contagious  diseases  respond  more  quickly  to  osteopathic 

treatment  than  to  medical  treatment  (case  18) 102 

Alimentary  tract  is  always  deranged  in  infantile  paralysis 62 

Ankle  corset 78 

Aneurysm — its  effects 35 

Another  M.  D.  mistaken  in  diagnosis 143 

Another  nine  months'  baby  cured  (case  19) 102 

Anterior  horn  cell  lesions 115 

Aorta  may  be  compressed  by  diaphragm 22 

Applied  anatomy 11,  36 

Arrangement  of  vasomotors  of  abdomen 21 

Arterial  anastomosis  not  free  in  grey  matter  of  spinal  cord 92 

Atmospheric  conditions  seemed  to  play  a  part.  . 128 

Atrophy  from  wearing  brace 80 

Atlas  lesion 32 

Attack  can  be  aborted 86 

Attack  followed  hard  play  (cases  41,  42) 124 

Autointoxication,  was  M.  D.'s  diagnosis  (cases  46,  47) 130 

Avoid  physical  exhaustion 64 

Axis  lesion 32 

Back  muscles  contract 63 

Backward  drawing  of  head 28 

Be  sure  and  adjust  lesions 35 

Better  health  often  follows  in  infantile  paralysis  patients  who  have 

been  treated  osteopathically 100 

Bladder  and  bowels  paralyzed  (case  43) 126 

Bladder  control  lost , \  ;. 86 

Blood  supply  of  spinal  cord • 11 


INDEX  155 

Body's  resistance  lowered  in  hot  months 62 

Boned  waist  for  weak  spine 78 

Bony  lesions  must  be  adjusted 150 

Boy  had  homeopath  and  allopath,but  begged  for  osteopath  (cases  12, 13)  96 

Brandy  given  by  medical  doctor 96 

Braces  taken  off  immediately 76 

Bulbar  paralysis 28 

Bulbar  paralysis  cured 71 

Bulbar  paralysis  cured  after  five  years 77 

Can  infantile  paralysis  be  prevented? 60 

Can  babies  be  treated  osteopathically,  is  often  asked.   See  case  16.  ..  99 

Case  considered  hopeless  by  medical  doctors  (case  16) 98 

Case  Reports  begin 81 

Causes 5 

Caution 57 

Central  nervous  system  is  directly  involved  in  infantile  paralysis 32 

Cervical  enlargement  of  spinal  cord  most  of  ten  attacked  in  poliomyelitis  17 

Cervical  lesions 15 

Cervical  rib 35 

Child  begged  to  be  treated 69 

Child  fell  from  ladder 122 

Child  walked  after  three  treatments 75 

Children  are  irrepressible 63 

Cheyne-Stokes  respiration 95 

Clinic  Cases 43 

Coeliac  plexus 21 

Cold  feet 24 

Cole's  Metal  Sigmoid  Irrigator  recommended 150 

Congestion  of  head  and  neck 26 

Contracted  musculature 13 

Cord  cell  tonicity  necessary  to  normal  functioning 39 

Cold  compresses 54 

Cold  pack  gave  good  results,  (case  18) 101 

Colossal  conceit 64 

Contracted  muscles  of  the  back 63 

Cold  compresses  about  the  neck 82 

Cord  circulation  blocked  at  both  ends 81 

Coma  and  delirium 95 

Congestion  of  cord  compared  to  congestion  of  lungs  in  early  lobar 

pneumonia 91 

Convulsions  ceased  under  osteopathic  treatment 144 

Cure  possible  when  treatment  is  kept  up  (case  39) 121 


156  POLIOMYELITIS 

Cured  after  two  years  in  hospital  under  medical  treatment 151 

Daily  hot  bath 82 

Damage  to  tissues  during  night  while  child  is  quiet 143 

Developed  after  extreme  fatigue 81 

Diagnosed  as  sciatica  by  M.  D.  (case  36) • .  .  119 

Diagnosed  as  a  "grippy  cold"  (case  37) 119 

Diagnosed  as  hip  disease  (case  40) 121 

Diagnosis  in  the  early  stage  not  always  easy 88 

Diaphragm 15 

Diaphragmatic  pressure  on  nerves,  vessels,  tubes,  etc.,  passing 

through  its  openings 40 

Diet  should  be  restricted 136 

Diseased  organs  always  have  disturbed  circulation 38 

Diseased  tonsils  favor  infection 28 

Discovered  in  Europe  in  1840 115 

Do  not  be  afraid  to  call  an  osteopath 64 

Don't  give  up  too  soon 78 

Drainage  of  spinal  veins 13 

Drainage  of  spinal  vessels  better  in  prone  posture 54 

Dr.  Gair  begged  for  a  chance  to  help  infantile  paralysis  victims 66 

Dr.  Gair  had  fifty  cases  first  winter 66 

Early  cases  make  the  best  showing  (cases  14,  15) 97 

Early  treatment  by  osteopath  advised 71 

Ears  sometimes  involved 74 

Eat  less  heat  producing  food  in  summer 62 

Eats  galore 62 

Effect  of  lesions  on  lymphatics 30 

Effects  of  costal  lesions 22 

Effects  of  muscular  activity -. 63 

Efferent  impulses 39 

Electrical  treatment  in  acute  stage  not  well  borne  (case  35) 114 

Eliminate  the  "mixers" 97 

Emphasize  necessity  of  early  treatment  regardless  of  the  severity  of 

the  case 93 

Enemata  necessary  in  acute  cases 71 

Even  the  slightest  subluxation  must  be  corrected 48 

Examination  of  spine  is  important 24 

Exercises  in  later  convalescence 69 

Exercises  help  in  later  stages 84 

Extremities  involved  must  receive  attention 45 

Extreme  hyperemia  and  capillary  pulse 140 

Falls,  tumbles 8 


INDEX  157 

Fear  is  prejudicial  to  making  best  progress 90 

Fecal  discharges  of  infantile  paralysis  cases  very  offensive 55 

Feeding  in  infantile  paralysis 52 

Fell  out  of  wagon  on  head  (case  32) 113 

Feverish  condition  of  head 28 

First  rib  lesion 34 

Flux  in  some  cases 74 

Food  a  vehicle  of  infection 9 

Frequent  colon  flushings  indicated  in  acute  cases 55 

Fruit  juices  and  water  during  fever 150 

Gargle  of  hot  water  and  vinegar 149 

General  management 117 

Getting  cases  after  two  years  of  medical  treatment 76 

Give  close  attention  to  mucous  surfaces  of  nose  and  throat 57 

Got  worse,  instead  of  better 152 

Had  disease  at  age  of  one  year;  never  used  right  hand  after  (case  38) .  .  120 

Had  attack  while  broken  arm  was  in  a  case  (cast  55) 139 

Headache  a  symptom  in  infantile  paralysis 25 

Hernmorhagic  foci  in  affected  portion  of  core  tissues 91 

Hints  to  the  Public  on  Infantile  Paralysis 60 

History  of  falls  in  many  cases 78 

History  of  falls 88 

History  of  a  fall,  previous  to  attack  (cases  21,  22) 104 

How  long  should  cases  be  treated 58 

Hospitals  of  New  York  closed  to  osteopaths 65 

Hot  bath  recommended 142 

Hot  compression  very  sensitive  cases 54 

Hot  compresses  promote  drainage 54 

Hot,  humid  weather  favors  the  development  of  infantile  paralysis.  ...   63 

Hydrotherapy 53 

Hyperesthesia  pronounced 129 

Hypnotism,  said  the  medical  doctors 78 

Ice  packs  used 95 

Indurated  lymph  nodes  due  to  impeded  circulation 28 

Infantile  paralysis  not  as  general  in  families  as  other  infectious  dis- 
eases, such  as  scarlet  fever,  measles,  whooping  cough,  etc 32 

Infantile  Paralysis — E.  Florence  Gair,  D.  0 65 

Infantile  paralysis  epidemic  in  New  York,  summer  1916 64 

Infection  enters  cord  substance  through  lymph  spaces  between  pia- 

mater  and  arachnoid 36 

Infection  thru  lacteals  and  blood  channels 25 

Infection  thru  lymphatics  of  head  and  neck 25 


158  POLIOMYELITIS 

Infectious,  but  not  contagious — an  opinion — (cases  28,  29) 110 

Improvement  continued  after  quitting  treatment  (case  26) 107 

Improvement  slow  in  some  chronic  cases 74 

Improvement  soon  noticed 84 

Inoculation  not  necessary  in  well-marked  cases 125 

Intelligent  nursing  an  important  factor  (case  16) 98 

Intelligent  nursing  of  great  value  (case  27) 108 

Interference  by  visiting  medical  nurse 78 

Intestinal  diseases  more  frequent  in  hot  weather 63 

Instrument-deli vered  babies 5 

Irrigate  the  colon 55 

Irritability  marked  in  many  cases 86 

Judgment  quite  as  essential  as  skill 135 

Just  and  unbiased,  was  this  M.  D 144 

Keep  patient's  feet  warm 57 

Kiddie  kar,  the  tricycle  and  velocipede  good  for  lower  limbs 79 

Know  nature's  method  of  fighting  disease 141 

Leg  brace  seldom  necessary  (cases  9,  10) 94 

Lesion  of  clavicle 34 

Lesion  of  hyoid  bone 32 

Lesion  theory 5 

Lesions  present 82 

Liquid  diet 72 

Lumbar  lesion 22 

Lymph  nodes  of  neck  enlarged 26 

Lymphatics  of  the  head  and  neck 25,    30 

Lymphatics  of  thorax  and  abdomen 36 

Many  bulbar  paralysis  cases  cured 77 

Many  infantile  paralysis  victims  give  a  history  of  being  very  active .  .   63 

Maternal  persistence  rewarded  (a  case  from  the  80's) 68 

Mechanical,  electrical  machines  not  advised 79 

M.  D.  admits  osteopathic  treatment  was  most  effective 144 

M.  D.  commends  osteopathic  treatment 143 

M.  D.  thought  Osteopathy  would  help  (case  48) 132 

Medical  octopus 65 

Medical  doctor  advised  Osteopathy 95 

Medical  doctors  disparage  results  obtained  by  Osteopathy 78 

Medical  prognoses  at  sea — case  23,  page  105;  case  25 107 

Medical  treatment  a  failure 52 

Medical  treatment  of  infantile  paralysis 150 

Medical  treatment  unsatisfactory 149 

Mental  effort  on  part  of  patient  necessary  to  secure  best  results 79 


INDEX  159 

Mixed  infection 3g 

Mode  of  infection 9 

Moderation  necessary 62 

Motor,  vasomotor  and  trophic  impulses  affected  by  ligamentous  and 

osseous  lesions 19 

Much  cloudy  weather  in  1916  which  affected  atmospheric  conditions  87 

Muscular  atrophy 24 

Nature  will  do  wonders  if  assisted 67 

Nature  must  not  be  handicapped 24 

Nature  must  rehabilitate 58 

Nerve  irritation  lowers  tissue  resistance 42 

Never  say  die 153 

Nine  months  baby  cured  after  suffering  from  disease  three  months — 

case  16 98 

Ninety  per  cent  could  be  cured,  says  osteopath — (case  17) 100 

No  specific  serum  has  been  found 49 

No  wonder  nature  rebels 62 

Normal  circulation  the  greatest  preventative 30 

Normal  pharyngeal  and  nasal  tissues  more  resistant  to  infection 28 

Nostrils  require  attention 149 

Notional  about  food 81 

Nutrition  impaired  by  wearing  casts  and  braces 79 

Objection  to  treatment  on  part  of  infants  does  not  prove  that  the  treat- 
ment hurts — (case  16) 99 

Obstipation 41 

Oil  spray  for  nose 149 

One  case  left  entirely  to  nature  as  an  experiment  by  Rockefeller  Insti- 
tute authorities 65 

Only  case,  though  others  exposed 85 

"  Operate, "  said  the  home  town  physician 75 

Opisthotonos 81 

Organs  become  infected  through  their  vascular  channels — the  blood 

and  the  lymph 39 

Organism  causing  the  disease  circulates  in  the  body  fluids 116 

Orthopedic  surgery 145 

Osteopath  should  get  case  early 64 

Osteopathy  in  acute  cases 49 

Osteopathy  is  the  natural  treatment  for  infantile  paralysis 64 

Osteopathy  goes  to  centre  of  trouble -80 

Osteopathy  the  only  logical,  sensible,  curative  treatment 80 

Osteopathy  specific  if  applied  early -84 

Osteopathic  treatment  in  the  acute  stage  is  especially  indicated 90 


1GO  POLIOMYELITIS 

Osteopathic  treatment,  versus  medical  treatment — (case  8) 92 

Osteopathic  results  versus  medical  results  (case  23) 105 

Osteopathic  and  medical  results  compared  (case  31) Ill,  112 

Osteopathy  won  after  three  medical  doctors  gave  up  case — (case  16) .  .98 

Osteopathy  is  usually  the  last  resort — (case  17) 100 

Paralysis  due. to  fall  down  stairs  (case  33) 113 

Paralysis  of  bladder  and  bowels 22 

Parents  not  persistent  enough  (case  30) 110 

Parents  must  have  courage 74 

Patient  must  be  guarded  in  convalescent  stage 57 

Paths  of  conveyance  of  virus  to  membranes  of  brain  and  spinal  cord .  .   25 

Pathology  changes  as  case  progresses 91 

Pathological  fermentation  takes  place  more  readily  in  summer 62 

Pathological  state  of  spinal  cord  develops  early  in  the  acute  stage ....   90 

Phenomenal  results  in  some  cases 71 

Physician  contracted  infection  (cases  28,  29) 110 

Physician  sometimes  has  to  be  nurse  (case  34) 113 

Plant  life  affected  in  summer  of  1916 87 

Poliomyelitis  more  severe  in  children  whose  spines  have  lesions 19 

Policy  of  medical  doctors  is,  hands  off 52 

Predisposing  causes 60 

Preganglionic  and  postganglionic  nerve  fibers 21 

Prevention  the  watchword 60 

Procedure  in  acute  cases 52 

Prognosis 117 

Prognosis  difficult  in  long-standing  cases 70 

Prognosis  grave,  said  the  M.  D.  (case  40) 121 

Prolonged  period  of  treatment  often  necessary.  .  . 94 

Pronounced  coryza  in  some  severe  cases 75 

Proper  vision 45 

Quick  ridding  of  toxins  necessary 149 

Rapid  response,  though  child  had  not  been  strong 95 

Reaction  of  muscles  and  muscle  tone  are  of  first  importance  in  diag- 
nosing cases  not  well  defined 89 

Recovery  complete 73 

Regeneration  of  dead  cells  impossible 91 

Relapses 57 

Relapses  sometimes  occur 73 

Remove  the  lesion 43 

Renal  plexus 22 

Rest  and  quiet  indicated  in  convalescence 57 

Restless..  .  86 


INDEX  161 

Resistance  exercises  help  (case  27) 108 

Resistance  exercises  best 79 

Resort  to  surgery,  plaster  casts,  braces  only  when  everything  else  has 

failed 67 

Resolution  of  initial  congestion,  by  osteopathic  treatment,  is  logical 

course  to  pursue 91 

Results  all  that  could  be  desired  (case  24) 105 

Rib  lesions 22 

Rockefeller  Institute  is  controlled  by  the  great  medical  octopus 65 

Rockefeller  Institute  fails 65 

Rockefeller  Institute  a  biased  investigator 65 

Rub  limbs  with  hot  olive  oil 72 

Sacral  lesions 23 

Sciatica 23 

Seeks  a  cool  place 63 

Semilunar  ganglia 21 

Sensitive  spines 53 

Severe  treatment  contra-indicated — (cases  9,  10) 92 

She  couldn't  walk  two  blocks — now  cured 152 

Short  treatment  indicated 94 

Shrunken  limbs 60 

Simulated  spinal  meningitis 81 

Significance  of  grey  rami  of  dorsal  spinal  nerves 19 

Six  out  of  seven  cases  restored  to  normal — (cases  14,  15) 98 

Soldiers  with  "  flu  "  might  have  been  saved 150 

Specific  adjustment 45 

Specialists  said  nothing  could  be  done 71 

Soothing  effect  of  hot  compresses 54 

Spoiled  babies  make  it  difficult  for  the  physician  (case  16) 99 

Spinal  cord  of  the  child  is  not  fully  developed 63 

Splanchnic  nerves 22 

Spinal  nerve  cells — nerve  roots 15 

Stick  to  Dr.  Still's  teaching 46 

Stools  very  offensive 62 

Susceptibility 143 

Symptoms 116 

Symptoms  of  case  eight 92 

Symptoms  different  in  cerebral  cases 141 

Sympathetic  ganglia 21 

Static  blood  a  predisposing  cause 10 

St.  Vitus'  Dance  due  to  trauma 8 

Temperature 25 


162  POLIOMYELITIS 

"Ten-finger"  Osteopathy 43 

"Ten-fingered"  Osteopathy  does  the  work 97 

Tepid  bath  and  olive  oil  rub  (case  16) 98 

The  medicos  do  not  want  an  all-round  investigation 65 

The  number  of  cases  during  1916  epidemic  varied  with  the  humidity .  .   87 

The  osteopath  works  with  nature 149 

Things  to  guard  against 94 

Thoracic  duct  a  great  collecting  system 41 

Totally  paralyzed  from  waist  down,  child  made  complete  recovery  in 

six  weeks'  treatment 104 

Trauma 7 

Treatment — Part  One 43 

Treat  the  patient,  not  the  disease 90 

Treated  twice  a  day  at  first 81 

Treatment — gentle  relaxation,  strong  flexion  and  extension  of  spine .  .   86 

Treatment  raises  resistance 89 

Treatment  in  severe  cases 93 

Treatment  of  deformities  resulting  from  infantile  paralysis 145 

Trouble  with  Health  Officer 125 

Turn  on  face  to  let  spinal  cord  get  drainage 72 

Typhoid  fever  was  suspected  (case  50) 134 

Undried,  wrap  child  in  blanket 150 

Use  of  hot  bath 107,  142 

Value  of  rest  to  alimentary  tract 90 

Vegetable  broth 82 

Venous  stasis  precedes  nodular  enlargement 38 

Vertebra  artery 15 

Vigorous  treatment  when  sensitiveness  of  spine  is  overcome 94 

Vision 45 

Vomiting,  high  fever,  headache 104 

Water  to  fevered  patient 53 

Weakened  tissues  an  easy  prey  to  toxins 63 

Wearing  brace  causes  deformity  of  foot 80 

What  is  the  best  thing  for  the  public  to  do  in  infantile  paralysis 60 

What  should  be  done 64 

When  convalescence  begins  watch  the  bowels 55 

Where  does  treatment  of  acute  cases  begin 51 

Why  have  filthy  intestinal  tracts 62 

Why  put  braces  on  babies  not  yet  walking 76 

Withhold  foot  during  temperature  stage 81 

Wrist-drop  cured 75 

Youngest  patient  and  oldest  patient  I  have  known 143 


Date  Due 


PRINTED  IN  U.S.*.  CAT.     NO.     24     161 


A     000  421  815     2 


WC555 
M61*5p 
1918 


Millard,  Frederick  P. 
Poliomyelitis 


MEDICAL  SCIENCES  LIBRARY 

UNIVERSITY  OF  CALIFORNIA,  IRVINE 

IRVINE,  CALIFORNIA  92664 


